A–Z Index
Medical mnemonics and acronyms from A to Z
Browse all JACCOL entries alphabetically. Use filters to narrow the list.
7-3-2 ribs
7 true ribs, 3 false ribs, 2 floating ribs
A PALM Seed Makes Another Little Palm
Apical, Posterior, Anterior; Lateral, Medial; Superior, Medial, Anterior, Lateral, Posterior basal
AAA - Abdominal Aortic Aneurysm
Abdominal Aortic Aneurysm
ABCDE
Airway, Breathing, Circulation, Disability, Exposure
ABCDE Assessment
Airway, Breathing, Circulation, Disability, Exposure, treating as you go
Abdominal Aorta Branches
Coeliac at T12, superior mesenteric at L1, renals at L2, inferior mesenteric at L3, bifurcation at L4
Abdominal Aortic Aneurysm Anatomy
Usually infrarenal, palpable above the umbilicus, expansile rather than pulsatile
Abdominal Aortic Branch Mnemonic
Prostitutes Cause Sagging Swollen Red Testicles Living In Sin
Abdominal Incisions and Anatomy
Midline through the linea alba, gridiron at McBurney's point, Kocher for the gallbladder, Pfannenstiel for the pelvis
Abdominal Lymphatic Drainage
Nodes follow the arteries, coeliac, superior mesenteric and inferior mesenteric groups
Abdominal Radiograph Review
Bowel gas pattern, then solid organs, bones and calcification
Abdominal Wall Blood Supply
Superior and inferior epigastric arteries meet within the rectus sheath
Abdominal Wall Layers
Skin, Camper's and Scarpa's fascia, three muscle layers, transversalis fascia, extraperitoneal fat, peritoneum
Abdominal Wall Nerve Supply
T7 to T11 intercostal, T12 subcostal, L1 iliohypogastric and ilioinguinal
ABG
Arterial blood gas
Absorption Sites Along the Gut
Duodenum for iron and calcium, jejunum for most nutrients, ileum for B12 and bile salts
ACA - Anterior Cerebral Artery
Anterior Cerebral Artery
Accessory Muscles of Respiration
Sternocleidomastoid, scalenes and pectorals for inspiration; abdominal wall for expiration
Accessory Nerve Palsy Sign
Shoulder droops, can't shrug or turn the head away from the injured side
Accommodation Reflex Triad
Converge, constrict, contract the lens, three C's when you look up close
ACE Inhibitors and Angiotensin Receptor Blockers
Block angiotensin II, with cough from bradykinin
Acid Suppression and Gastroprotection
Proton pump inhibitors, H2 antagonists and antacids
Acid-Base Disorders - ROME
Respiratory Opposite, Metabolic Equal
Acid-Base Interpretation Steps
Check pH, then carbon dioxide, then bicarbonate, then compensation, then the anion gap
ACL - Anterior Cruciate Ligament
Anterior Cruciate Ligament
ACR - American College of Radiology
American College of Radiology
Acromegaly Features
Acral and soft tissue overgrowth with metabolic and mass effects
Action Potential Phases
Depolarisation by sodium influx, repolarisation by potassium efflux, then hyperpolarisation
Acute Asthma Severity Assessment
Moderate, acute severe, life threatening and near fatal
Acute Coronary Syndrome Classification
ECG first, then troponin, then the diagnosis follows
Acute Heart Failure Management
Sit up, oxygen, nitrates, diuretics, and treat the cause
Acute Kidney Injury Classification
Prerenal, intrinsic renal and postrenal
Acute Kidney Injury Staging
Staged by creatinine rise or urine output, classified as pre-renal, renal or post-renal
Acute Pericarditis
Two of four features: pain, rub, ECG changes, effusion
Acute Respiratory Distress Syndrome Pathology
Diffuse alveolar damage with non-cardiogenic pulmonary oedema
Acute Stroke Assessment
FAST to recognise, ROSIER to confirm, CT to exclude haemorrhage
Acute Tubular Necrosis
Ischaemic or toxic injury to tubular cells, with an oliguric then polyuric phase
Acute Versus Chronic Inflammation
Neutrophils and exudate in acute; lymphocytes, macrophages and fibrosis in chronic
ADC - Apparent Diffusion Coefficient
Apparent Diffusion Coefficient
Added Breath Sounds
Timing and character of the added sound localise the pathology
Adductor Canal Contents
Femoral artery, femoral vein, saphenous nerve and the nerve to vastus medialis
Adipose Tissue Types
White fat stores energy in a single droplet; brown fat generates heat
ADP
Adenosine diphosphate
Adrenal Blood Supply
Superior from the inferior phrenic, middle from the aorta, inferior from the renal artery
Adrenal Cortex Zones
Glomerulosa makes aldosterone, fasciculata makes cortisol, reticularis makes androgens
Adrenal Medulla and Catecholamines
A modified sympathetic ganglion secreting adrenaline and noradrenaline into the blood
Adrenal Steroid Synthesis Pathway
Cholesterol to mineralocorticoids, glucocorticoids and androgens
Adrenoceptor Effects in the Circulation
Alpha-1 vasoconstricts, beta-1 stimulates the heart, beta-2 vasodilates
Adult Advanced Life Support Algorithm
Two minute cycles, rhythm check, and the shockable or non-shockable arms
Adult Tooth Formula per Quadrant
I Can Predict Molars
Adverse Drug Reaction Types
ABCDE: Augmented, Bizarre, Chronic, Delayed, End of treatment
Afterload Determinants
Aortic pressure, systemic vascular resistance, ventricular radius and wall thickness
Ageing and the Cardiovascular System
Arteries stiffen, diastolic function declines, and maximum heart rate falls
Ageing and the Kidney
Nephron loss with falling GFR, reduced concentrating ability and blunted responses
Ageing and the Respiratory System
Loss of elastic recoil, stiffer chest wall, rising closing capacity and falling oxygen tension
Agonists and Antagonists
Agonists activate, antagonists block, partial agonists do both depending on context
Air Fluid Level in Sinusitis
A flat line on X-ray tells the tale, fluid pooling in a blocked sinus trail
Airway Histology from Trachea to Alveolus
Cartilage, glands, goblet cells and cilia all disappear distally
Airway Humidification
Gas is fully saturated at body temperature by the time it reaches the isothermic boundary
Airway Resistance
Medium-sized bronchi contribute most resistance, not the smallest airways
ALARA - As Low As Reasonably Achievable
As Low As Reasonably Achievable
Alcohol Screening Questions
CAGE: Cut down, Annoyed, Guilty, Eye opener
Alcohol Withdrawal Management
Long acting benzodiazepine plus thiamine, with seizure and delirium risk
Aldosterone Actions
Sodium in, potassium and hydrogen out, at the distal nephron
Aldosterone Versus Cortisol Specificity
11-beta-hydroxysteroid dehydrogenase inactivates cortisol in mineralocorticoid target tissues
All Physicians Take Money
Aortic, Pulmonary, Tricuspid, Mitral
ALT
Alanine aminotransferase
Alveolar Cell Types
Type I pneumocytes cover the surface, type II make surfactant, macrophages clean up
Alveolar Gas Equation
Inspired oxygen minus carbon dioxide divided by the respiratory quotient
Alveolar Ventilation Equation
Alveolar carbon dioxide is inversely proportional to alveolar ventilation
Alveolar-Arterial Gradient
A normal gradient points to hypoventilation or low inspired oxygen; a wide gradient points to lung disease
Ambulatory Blood Pressure Monitoring
Daytime average over at least 14 measurements, with lower thresholds
Ambulatory ECG Monitoring
Match the monitoring duration to the frequency of the symptoms
Amino Acid Classification
Nonpolar, polar, acidic and basic, determined by the R group
Aminoglycoside Monitoring
Concentration-dependent killing with a post-antibiotic effect, allowing once daily dosing
Amiodarone and the Thyroid
Type 1 is excess synthesis; type 2 is destructive thyroiditis
Amiodarone Monitoring
Lungs, liver, thyroid, eyes, skin and nerves
Ammonia Handling and Encephalopathy
Gut-derived ammonia is converted to urea by the liver; failure allows it to reach the brain
Ammonia Handling and Transamination
Transamination collects it, glutamine transports it, the urea cycle removes it
Ampulla of Vater
Union of the bile duct and main pancreatic duct opening into the second part of the duodenum
Amylase and Lipase
Lipase is more sensitive and specific and stays raised longer
Amyloidosis
Misfolded protein deposited as beta pleated sheets
Anaemia Classification by MCV
Microcytic, normocytic and macrocytic, each with a short differential
Anal Sphincters
Internal sphincter is smooth muscle and involuntary; external is skeletal muscle and voluntary
Anaphylaxis Management
Adrenaline intramuscularly into the anterolateral thigh, immediately
Anatomical Shunt in Health
Bronchial and thebesian veins drain deoxygenated blood into the systemic circulation
Anatomical Snuffbox Borders
Extensor Pollicis Longus, Extensor Pollicis Brevis, Abductor Pollicis Longus
Aneurysm Types
True aneurysms involve all layers; false aneurysms are contained ruptures
Angina Classification
Three features define typical angina
Angle of Jaw Dermatome Exception
The angle of the jaw belongs to C2, C3, not the trigeminal at all
Angular Artery Termination
The facial artery's last stop, at the eye's inner corner, full stop
Anion Gap
Sodium minus chloride and bicarbonate, normally 8 to 16 mmol per litre
Anion Gap in Respiratory Disease
The kidney adjusts bicarbonate over days to offset a change in carbon dioxide
Ankle Joint Movements
Dorsiflexion and plantarflexion at the ankle; inversion and eversion at the subtalar joint
Ansa Cervicalis Function
A loop of C1 to C3 supplies the strap muscles below the hyoid
Antenatal Screening Tests
Combined test, quadruple test, anomaly scan and infectious disease screening
Anterior Abdominal Wall Landmarks for Port Placement
Inferior epigastric vessels laterally, aorta and iliac vessels beneath the umbilicus
Anterior and Posterior Relations of the Kidney
Liver, duodenum and colon in front of the right; stomach, pancreas, spleen and colon in front of the left
Anterior Arm Compartment - BBC
Biceps brachii, Brachialis, Coracobrachialis
Anterior Chest Auscultation Hits the Upper Lobes
Anterior chest is mostly upper lobe; posterior chest is mostly lower lobe
Anterior Cranial Fossa Contents
Frontal lobes rest, olfactory bulbs nest, on the cribriform's crest
Anterior Forearm Flexor Layers
Superficial, intermediate and deep flexors of the forearm
Anterior Interosseous Nerve Syndrome - Lost OK Sign
Flexor pollicis longus, lateral half of flexor digitorum profundus and pronator quadratus
Anterior Leg Compartment
Tibialis anterior, Extensor hallucis longus, Extensor digitorum longus and Fibularis tertius, supplied by the deep fibular nerve
Anterior Pituitary Hormones
Growth hormone, prolactin, ACTH, TSH, FSH and LH
Anterior Pituitary Hormones - FLAT PIG
FSH, LH, ACTH, TSH, Prolactin, Insulin-like (IGF), GH
Anterior Thigh Compartment
Quadriceps femoris, sartorius, iliopsoas and pectineus, supplied mainly by the femoral nerve
Anterior Triangle Subdivisions
Some Men Cheat Downwards
Anterior Versus Posterior Rami
The anterior wall is supplied by anterior rami; the back muscles by posterior rami
Antiarrhythmic Drug Choice
Adenosine for supraventricular tachycardia, amiodarone broadly, digoxin for rate control
Antibiotic Mechanisms of Action
Cell wall, protein synthesis, nucleic acid and folate synthesis
Antibiotic Prophylaxis
Surgical, medical and post-exposure indications
Antibiotic Resistance Mechanisms
Enzymatic destruction, target alteration, reduced entry and efflux
Antibiotic Sensitivity Reporting
Susceptible, intermediate or resistant, defined against a breakpoint
Antibiotic Side Effects
Each class has a signature adverse effect
Antibiotic Spectrum by Organism
Gram positive, Gram negative, anaerobic and atypical cover
Anticholinergic Burden
Many drugs each contribute a little, and the total predicts harm
Anticoagulant Drug Mechanisms
Warfarin blocks vitamin K, heparin activates antithrombin, DOACs block Xa or thrombin
Anticoagulant Mechanisms
Antithrombin, protein C and S, and tissue factor pathway inhibitor
Antidepressant Classes
SSRIs, SNRIs, tricyclics and MAO inhibitors
Antidiuretic Hormone Action on the Kidney
It inserts aquaporin-2 channels into the collecting duct
Antidiuretic Hormone in the Circulation
Water retention through V2 receptors and vasoconstriction through V1 receptors
Antidotes to Common Poisons
Each major poison has a specific antidote acting by a defined mechanism
Antiemetic Selection
Choose the drug by the receptor pathway driving the nausea
Antiepileptic Drug Mechanisms
Sodium channel blockade, GABA enhancement or calcium channel blockade
Antifungal and Antiviral Mechanisms
Antifungals target ergosterol or the cell wall; antivirals target viral enzymes
Antihypertensive Classes
ACE inhibitors, calcium channel blockers, thiazides, then spironolactone or beta blockers
Antimetabolite Drug Targets
Folate, thymidylate, purine and ribonucleotide reductase pathways
Antimicrobial Stewardship
Start Smart Then Focus
Antiplatelet Drugs
Aspirin blocks thromboxane, clopidogrel blocks ADP, abciximab blocks GPIIb/IIIa
Antipsychotic Side Effects
Extrapyramidal effects with typicals, metabolic effects with atypicals
Antituberculous Therapy
RIPE: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol
Aortic Aneurysm Pathology
True or false, fusiform or saccular, with degeneration of the media
Aortic Arch Branches
Brachiocephalic trunk, left common carotid artery, left subclavian artery
Aortic Dissection
Tearing pain to the back, with unequal pulses
Aortic Hiatus Contents
Aorta, Azygos vein, Thoracic duct
Aortic Isthmus
The narrow segment just distal to the left subclavian artery, tethered by the ligamentum arteriosum
Aortic Regurgitation Signs
A wide pulse pressure produces a long list of eponyms
Aortic Sinuses of Valsalva
Right sinus gives the right coronary artery, left sinus gives the left, the posterior sinus is non-coronary
Aortic Stenosis Features
SAD: Syncope, Angina, Dyspnoea
AP - Anteroposterior
Anteroposterior
Apex Beat Surface Marking
Fifth intercostal space in the mid-clavicular line
Apnoea of Prematurity
Immature respiratory control with a paradoxical response to hypoxia
Apoptosis Versus Necrosis
Apoptosis is programmed and tidy; necrosis is accidental and inflammatory
Appendicular Artery
A single end artery running in the mesoappendix from the ileocolic artery
Appendix Positions
Retrocaecal, pelvic, subcaecal, preileal and postileal
Appetite Regulation
Ghrelin stimulates hunger; leptin, PYY and GLP-1 promote satiety
Approach to the Poisoned Patient
Resuscitate, identify, decontaminate, give an antidote, enhance elimination
Arches of the Foot
Medial longitudinal, lateral longitudinal and transverse arches
Arcuate Ligaments of the Diaphragm
Median over the aorta, medial over psoas major, lateral over quadratus lumborum
Arcuate Line Versus Arcuate Ligaments
The arcuate line is in the rectus sheath; the arcuate ligaments are on the diaphragm
ARDS Physiology
Diffuse alveolar damage causes non-cardiogenic oedema, shunt and stiff lungs
ARFI - Acoustic Radiation Force Impulse
Acoustic Radiation Force Impulse
Arterial Blood Gas Reading Order
Oxygenation first, then pH, then carbon dioxide, then bicarbonate
Ascending Aorta Relations
Runs within the pericardium from the aortic valve to the sternal angle, with the pulmonary trunk in front
Ascites and Shifting Dullness
Free fluid gravitates to the flanks while gas-filled bowel floats centrally
Ascitic Fluid Analysis
SAAG separates portal hypertension from everything else
ASPECTS - Alberta Stroke Programme Early CT Score
Alberta Stroke Programme Early CT Score
Aspiration Goes Right
The right main bronchus is Wider, Shorter and more Vertical
AST
Aspartate aminotransferase
Asthma and COPD Inhaled Therapy
Beta-2 agonists, antimuscarinics, corticosteroids and leukotriene antagonists
Asthma Diagnosis
Variable airflow obstruction, demonstrated objectively
Asthma Pathology
Inflammation, bronchoconstriction and airway remodelling
Asthma Physiology
Bronchoconstriction, gas trapping and hyperinflation with V/Q mismatch
Atherosclerosis Development
Endothelial injury, lipid entry, foam cells, fatty streak, then fibrous plaque
Atlanto-occipital Versus Atlantoaxial Movement
Atlas nods yes, axis says no
Atlas and Axis Distinguishing Features
Atlas has no body, axis has the peg
ATP
Adenosine triphosphate
ATP Production Pathways
Glycolysis, the Krebs cycle and oxidative phosphorylation
Atrial Fibrillation Management
Rate or rhythm, plus stroke prevention, considered separately
Atrial Septation
Septum primum and septum secundum overlap to leave the flap valve of the foramen ovale
Atypical Ribs
Ribs 1, 2, 10, 11 and 12 are atypical
AUC - Area Under Curve
Area Under Curve
Auriculotemporal Nerve Relation to the Middle Meningeal Artery
Wraps around the middle meningeal artery like a sling
Autoantibodies and Their Diseases
Each autoimmune disease has a characteristic antibody profile
Autoantibody Associations
Antinuclear antibody first, then the specific antibodies
Autoimmune Disease Mechanisms
Central and peripheral tolerance, and the ways each fails
Automaticity Hierarchy
Sinoatrial node 60 to 100, atrioventricular junction 40 to 60, ventricle 20 to 40
Autonomic Effects on the Heart
Chronotropy, inotropy, dromotropy and lusitropy
Autonomic Nervous System Comparison
Sympathetic is thoracolumbar with short pre and long postganglionic fibres; parasympathetic is craniosacral and the reverse
Autoregulation of Blood Flow
Myogenic and metabolic mechanisms hold flow steady despite changing pressure
AVN - Avascular Necrosis
Avascular Necrosis
Axillary Nerve Lesion - Regimental Badge
Deltoid weakness and regimental badge sensory loss
Axillary Tail of Spence
The upper outer quadrant extends into the axilla through the deep fascia
AXR - Abdominal X-Ray
Abdominal X-Ray
Azygos Lobe
A normal variant formed when the azygos vein cuts through the apex of the right upper lobe
Azygos Venous System
Azygos on the right, hemiazygos and accessory hemiazygos on the left
B Cell Activation and Class Switching
Antigen binding plus T cell help drives class switching and affinity maturation
B12 and Folate Testing
Serum levels, then the metabolites, then the cause
BA - Barium
Barium
Back Pain Red Flags
Features suggesting malignancy, infection, fracture or cauda equina
Bainbridge and Bezold-Jarisch Reflexes
Bainbridge speeds the heart with atrial stretch; Bezold-Jarisch slows it
Baroreceptor Reflex
Carotid sinus and aortic arch stretch receptors adjust autonomic outflow within seconds
Basal Ganglia Circuits
The direct pathway facilitates movement; the indirect pathway inhibits it
Basal Metabolic Rate
Energy expenditure at rest, mainly determined by lean body mass
Base Excess and Standard Bicarbonate
Base excess quantifies the metabolic component independently of carbon dioxide
Basement Membrane Structure
Basal lamina of lamina lucida and lamina densa, plus a reticular lamina
Batson's Vertebral Venous Plexus
A valveless network connecting thoracic, pelvic and vertebral veins
BATTLE
Brachiocephalic veins, Aortic arch, Thymus, Trachea, Lymphatics, (o)Esophagus
Battle's Sign for Base of Skull Fracture
Bruising behind the ear, base of skull fracture's here
Beck's Triad
Hypotension, raised jugular venous pressure, muffled heart sounds
Bell's Palsy Versus Stroke Forehead Sparing
Bell's drops it all, stroke spares the wall
Benign Versus Malignant Tumours
Malignant tumours invade, metastasise, grow rapidly and show cellular atypia
Benzodiazepines and Z Drugs
GABA-A enhancement giving anxiolysis, sedation, anticonvulsant and muscle relaxant effects
BEST
Brachioradialis, Extensors, Supinator, Triceps
Beta Blocker Selectivity
Cardioselective agents spare beta-2 receptors; non-selective agents do not
Beta Lactam Classes
All inhibit cell wall synthesis, differing in spectrum and stability
BI-RADS - Breast Imaging Reporting and Data System
Breast Imaging Reporting and Data System
Biceps Brachii - Strongest Supinator
Flexes the elbow and is the most powerful supinator of the forearm
Bile Acid Synthesis
Cholesterol to bile acids via 7-alpha-hydroxylase, the rate-limiting step
Bile Composition and Function
Bile salts, phospholipids, cholesterol, bilirubin and bicarbonate
Biliary Tree Anatomy
Right and left hepatic ducts join as the common hepatic duct, which the cystic duct joins to form the common bile duct
Bilirubin in the Neonate
High red cell turnover with immature conjugation and enterohepatic recycling
Bilirubin Metabolism
Unconjugated bilirubin is conjugated in the liver, excreted in bile, and converted to urobilinogen
Bioavailability and First Pass Metabolism
The fraction of a dose reaching the systemic circulation unchanged
Biopsy Technique Choice
More tissue gives more information but carries more risk
Bitter Taste Receptor Distribution
Bitter lingers at the back, a built-in poison-detecting tack
Bladder Trigone
A smooth triangular area between the two ureteric orifices and the internal urethral meatus
Blood Brain Barrier Structure
Tight junctions, basement membrane and astrocyte foot processes
Blood Culture Principles
Two sets, separate sites, adequate volume, before antibiotics
Blood Film Abnormalities
Each morphological abnormality points to a specific diagnosis
Blood Groups and Compatibility
Group O is the universal red cell donor; group AB the universal plasma donor
Blood Pressure Measurement Technique
Cuff size, position, rate of deflation and repetition
Blood Vessel Wall Layers
Tunica intima, media and adventitia, in differing proportions by vessel type
Blood Viscosity and Haematocrit
Viscosity rises steeply with haematocrit, so optimal delivery occurs at an intermediate value
Blood Volume Distribution
About 70 per cent in the venous system, 15 per cent arterial, 5 per cent capillary
Blood-Air Barrier
Alveolar epithelium, fused basement membranes, capillary endothelium
Blood-Brain Barrier
Tight junctions between endothelial cells, supported by astrocyte foot processes
Blotting Techniques
SNoW DRoP: Southern DNA, Northern RNA, Western Protein
Body Buffer Systems
Bicarbonate in extracellular fluid, haemoglobin in blood, protein and phosphate in cells, bone in chronic acidosis
Body Fluid Compartments
Total body water 60 per cent, two-thirds intracellular, one-third extracellular
Bohr and Haldane Effects
Bohr is carbon dioxide affecting oxygen carriage; Haldane is oxygen affecting carbon dioxide carriage
BOLD - Blood-Oxygen-Level Dependent
Blood-Oxygen-Level Dependent
Bone Histology
Osteons of concentric lamellae around a central canal
Bone Marrow and Haematopoiesis
Red marrow is haematopoietic; yellow marrow is fat
Bone Physiology and Loading
Bone remodels along lines of stress, according to Wolff's law
Bone Protection Drugs
Bisphosphonates, denosumab, teriparatide and romosozumab
Bone Remodelling Control
Osteoblasts build, osteoclasts resorb, coupled through RANK ligand
Bone Types and Structure
Compact bone in osteons, cancellous bone in trabeculae
Bones of the Foot - 7, 5, 14
7 tarsals, 5 metatarsals and 14 phalanges make 26 bones
Bones of the Hand - 8, 5, 14
8 carpals, 5 metacarpals and 14 phalanges make 27 bones
Boundaries of the Femoral Triangle
Inguinal ligament above, sartorius laterally, adductor longus medially
BP
Blood pressure
Brachial Plexus Cords - Named by the Axillary Artery
Lateral, Medial and Posterior cords named by their relation to the axillary artery
Bradycardia and Pacing Indications
Atropine first, then the risk factors for asystole
Brain Herniation Syndromes
Subfalcine, uncal, central and tonsillar
Brain Tumour Types
Metastases outnumber primaries, and glioblastoma is the commonest primary
Branched Chain Amino Acids
Leucine, isoleucine and valine, metabolised in muscle not liver
Breast Arterial Supply
Internal thoracic perforators, lateral thoracic, thoracoacromial and posterior intercostal arteries
Breast Development and Milk Composition
Colostrum first, then transitional and mature milk
Breast Lymphatic Drainage
About 75 per cent to the axillary nodes, most of the rest to the parasternal nodes
Breast Structure
Fifteen to twenty lobes, each draining by a lactiferous duct to the nipple
Breath-Holding Physiology
Rising carbon dioxide is the main stimulus, with falling oxygen contributing later
Bronchial Asthma Mediators
Histamine and leukotrienes early, cellular infiltration late
Bronchial Tree Branching Order
Trachea, main, lobar, segmental bronchi, then bronchioles, terminal and respiratory bronchioles, alveolar ducts and sacs
Bronchial Versus Pulmonary Circulation
Pulmonary vessels carry blood for gas exchange; bronchial vessels nourish the lung tissue
Bronchiectasis
Permanent bronchial dilatation from chronic infection and inflammation
Bronchopulmonary Segments
Ten segments on the right, eight to ten on the left
Buccinator Function During Chewing
The trumpeter's cheek, keeps the food where you chew, doesn't let it leak
Bundle Branch Block Patterns
WiLLiaM MaRRoW: left gives W in V1 and M in V6; right gives M in V1 and W in V6
Bundle Branch Block Recognition
WiLLiaM MaRRoW: W in V1 and M in V6 is left, M in V1 and W in V6 is right
Burns Assessment
Rule of nines for area, Parkland formula for fluid
C-RADS - CT Colonography Reporting and Data System
CT Colonography Reporting and Data System
C1 - Cervical vertebra 1
Cervical vertebra 1
C2 - Cervical vertebra 2
Cervical vertebra 2
C3, 4, 5 keeps the diaphragm alive
C3, C4 and C5 contribute to the phrenic nerve
C5 - Cervical vertebra 5
Cervical vertebra 5
C5, C6, C7 Raise Your Wings to Heaven
Long thoracic nerve arises from roots C5, C6 and C7
C6 - Cervical vertebra 6
Cervical vertebra 6
C7 - Cervical vertebra 7
Cervical vertebra 7
Calcium Channel Blockers
Dihydropyridines act on vessels, non-dihydropyridines on the heart
Calcium Correction and Interpretation
Correct for albumin, then use the parathyroid hormone
Calcium Handling by the Kidney
Mostly passive in the proximal tubule and loop, actively regulated in the distal tubule
Calcium Regulation
Parathyroid hormone and vitamin D raise calcium; calcitonin lowers it
Calot's Triangle
Cystic duct, common hepatic duct and the inferior border of the liver
Camper's and Scarpa's Fascia
Camper's is the fatty Cushion, Scarpa's is the Sheet
Capacity Assessment
Understand, retain, weigh and communicate
Capillary Exchange Mechanisms
Diffusion for gases, bulk flow for water, vesicular transport for large molecules
Capillary Types
Continuous, fenestrated and sinusoidal, in increasing permeability
Carbohydrate Digestion
Amylase to oligosaccharides, brush border enzymes to monosaccharides, then transport
Carbon Dioxide Transport
Bicarbonate about 70 per cent, carbamino about 23 per cent, dissolved about 7 per cent
Carbon Monoxide and Cyanide Poisoning
Carbon monoxide blocks oxygen carriage; cyanide blocks its use
Carbon Monoxide Poisoning Physiology
It binds haemoglobin 240 times more avidly than oxygen and shifts the curve left
Carcinogens and Their Tumours
Each agent has a characteristic tumour
Cardiac Action Potential Phases - All Points Reach Plateau, Restore
All Points Reach Plateau, Restore
Cardiac Arrest Rhythms
Two shockable, two non-shockable, and the four Hs and four Ts
Cardiac Autonomic Supply
Sympathetic from T1 to T5, parasympathetic from the vagus
Cardiac Axis Determination
Both positive is normal; leads pointing away from each other indicate deviation
Cardiac Biomarkers
Troponin is the standard, rising at 3 to 6 hours and remaining raised for days
Cardiac Borders on the Chest Radiograph
Right border is right atrium; left border is aortic knuckle, pulmonary trunk, left atrial appendage and left ventricle
Cardiac Conduction Pathway
Sinoatrial node, atrioventricular node, bundle of His, bundle branches, Purkinje fibres
Cardiac CT and MRI Indications
CT for the arteries, MRI for the muscle
Cardiac Cycle Phases
Atrial systole, isovolumetric contraction, ejection, isovolumetric relaxation, then filling
Cardiac Fibrous Skeleton
Four fibrous rings that anchor the valves, attach the myocardium and insulate atria from ventricles
Cardiac Muscle Histology
Branching striated fibres with central nuclei and intercalated discs
Cardiac Muscle Versus Skeletal Muscle
Cardiac muscle is a functional syncytium with a long refractory period and cannot tetanise
Cardiac Output Determinants - PRSH
Preload, Rate, Stroke volume, Heart contractility
Cardiac Output Equation
Cardiac output equals heart rate multiplied by stroke volume
Cardiac Output Measurement
Fick principle, indicator dilution, thermodilution, Doppler and pulse contour analysis
Cardiac Referred Pain
Cardiac afferents enter the cord at T1 to T4 and are misattributed to those dermatomes
Cardiac Refractory Periods
Absolute refractory period prevents tetany; the relative period allows vulnerable re-excitation
Cardiac Sulci
Coronary sulcus between atria and ventricles, interventricular sulci between the ventricles
Cardiac Tamponade Physiology
Equalisation of diastolic pressures with impaired filling and pulsus paradoxus
Cardiac Work and Efficiency
Pressure work is far more costly in oxygen than volume work
Cardinal Signs of Inflammation
Rubor, calor, tumor, dolor and functio laesa
Cardiomyopathy Types
Dilated, hypertrophic and restrictive, each with a distinct physiology
Cardiothoracic Ratio
Maximum cardiac width divided by maximum thoracic width, normally less than 0.5
Cardiovascular Examination Sequence
Hands, pulse, face, neck, praecordium, then back and legs
Cardiovascular Response to Altitude
Immediate tachycardia and hyperventilation, then polycythaemia and pulmonary hypertension
Cardiovascular Response to Exercise
Cardiac output rises, resistance falls, and flow is redistributed to muscle
Carina Vertebral Level
The carina lies at the level of the sternal angle, T4 to T5
Carotid Bifurcation Vertebral Level
Carotid splits at C3 to C4, right where the hyoid bone lives
Carotid Canal Contents
The tunnel the artery takes, no nerve for company's sake
Carotid Pulse Palpation Landmark
Feel the angle of the jaw, just in front of the SCM's wall
Carotid Sheath Contents
Very Important Vessels Nearby
Carpal Tunnel Contents - 9 Tendons and 1 Nerve
Four flexor digitorum superficialis tendons, four flexor digitorum profundus tendons, one flexor pollicis longus tendon and the median nerve
Carrying Angle of the Elbow
Normal carrying angle is about 5 to 15 degrees; increased is cubitus valgus and decreased is cubitus varus
Cartilage Types
Hyaline, elastic and fibrocartilage, differing in fibre content
Causes of Clubbing
Respiratory, cardiac, gastrointestinal and endocrine causes
Causes of Hypoxaemia
Low inspired oxygen, hypoventilation, diffusion impairment, V/Q mismatch, shunt
Causes of Oedema
Raised hydrostatic pressure, low oncotic pressure, increased permeability, lymphatic obstruction
Causes of Thrombocytopenia
Reduced production, increased destruction, sequestration or spurious
Caval Opening Contents
Inferior vena cava and the right phrenic nerve
Cavernous Sinus Contents
Oh Oh Oh To Take A Vacation
Cavernous Sinus Thrombosis Signs
Painful eye that won't move right, three four six caught in the fight
CBCT - Cone Beam CT
Cone Beam CT
CBD - Common Bile Duct
Common Bile Duct
CECT - Contrast-Enhanced CT
Contrast-Enhanced CT
Celiac, SMA, IMA
Celiac trunk supplies foregut; SMA supplies midgut; IMA supplies hindgut
Cell Cycle Phases
G1, S, G2 and M, with checkpoints controlled by cyclins and p53
Cell Junction Types
Tight junctions seal, adherens and desmosomes anchor, gap junctions communicate
Cell Membrane Structure
A phospholipid bilayer with proteins floating in it
Cell Membrane Transport Mechanisms
Simple and facilitated diffusion, primary and secondary active transport, and vesicular transport
Cell Organelles and Functions
Nucleus, endoplasmic reticulum, Golgi, mitochondria, lysosomes and peroxisomes
Cell Renewal Categories
Labile, stable and permanent cell populations
Cell Signalling Mechanisms
Ion channel, G protein coupled, enzyme linked and intracellular receptors
Cells of Acute and Chronic Inflammation
Neutrophils first, macrophages next, lymphocytes for the long term
Cellular Adaptations
Hypertrophy, hyperplasia, atrophy, metaplasia and dysplasia
Central Dogma
DNA to RNA to protein, by replication, transcription and translation
Central Venous Pressure Interpretation
It reflects right atrial pressure, which depends on volume, cardiac function and compliance
Cerebellar Cortex Layers
Molecular, Purkinje and granular, from surface inwards
Cerebellar Function
DANISH: Dysdiadochokinesia, Ataxia, Nystagmus, Intention tremor, Slurred speech, Hypotonia
Cerebral Blood Flow Control
Carbon dioxide is the most powerful cerebral vasodilator
Cerebral Cortex Functional Areas
Frontal for motor and executive, parietal for sensation, temporal for hearing and memory, occipital for vision
Cerebrospinal Fluid Interpretation
Cells, protein, glucose and appearance distinguish the meningitides
Cerebrospinal Fluid Physiology
Produced by choroid plexus, circulates through the ventricles, absorbed by arachnoid granulations
Cervical Lymph Node Levels
Submental to supraclavicular, level one to level six
Cervical Pleura Above the Clavicle
The apex rises 2 to 3 cm above the medial third of the clavicle
Cervical Plexus Cutaneous Branches
Great auricular, lesser occipital, supraclavicular, transverse cervical, GLST meet at Erb's point
Cervical Plexus Root Value
C1 to C4 weave the neck's own web
Cervical Sympathetic Chain Ganglia
Superior Middle Inferior, three ganglia in a row
Cervical Vertebrae Versus Cervical Nerve Count
Seven bones, eight nerves, C1 exits above its bone, the rest just follow
CEUS - Contrast-Enhanced Ultrasound
Contrast-Enhanced Ultrasound
CHA2DS2-VASc Score
Congestive failure, Hypertension, Age, Diabetes, Stroke, Vascular, Age, Sex
Charcot's Triad and Reynolds' Pentad
Fever, jaundice and right upper quadrant pain; add hypotension and confusion for the pentad
CHD - Common Hepatic Duct
Common Hepatic Duct
Chemical Mediators of Inflammation
Cell-derived mediators such as histamine, and plasma-derived cascades
Chemoreceptor Reflex
Peripheral chemoreceptors sense oxygen; central chemoreceptors sense carbon dioxide
Chemotherapy Emergencies
Neutropenic sepsis, tumour lysis, spinal cord compression and hypercalcaemia
Chest Radiograph Systematic Review
ABCDE: Airway, Breathing, Circulation, Diaphragm, Everything else
Chest Signs by Pathology
Percussion note, breath sounds and vocal resonance identify the pathology
Chest Wall Layers
Skin, fascia, muscle, three intercostal layers, endothoracic fascia, parietal pleura
Chloride Shift
Bicarbonate leaves the red cell in exchange for chloride entering
Choking Management
Mild or severe, decided by whether the patient can cough effectively
Cholesterol and Lipoprotein Metabolism
Chylomicrons carry dietary fat, VLDL endogenous fat, LDL delivers cholesterol, HDL returns it
Cholesterol Synthesis
Acetyl-CoA to mevalonate via HMG-CoA reductase, the rate-limiting step
Choosing an Imaging Modality
Radiation, availability, contrast risk and what the question is
Chorda Tympani Route Through the Middle Ear
Sneaks through the middle ear, but doesn't supply it, just passing through
Chronic Kidney Disease Adaptation
Remaining nephrons hyperfilter, which compensates but accelerates decline
Chvostek's Sign for Hypocalcaemia
Tap the cheek, twitch you'll see, low calcium's the guarantee
CI - Confidence Interval
Confidence Interval
Ciliary Ganglion Root
Short root, sharp focus
Circle of Willis Order
Anterior communicates before posterior
Cirrhosis Complications
Portal hypertension and hepatocellular failure, each with its own complications
CIS
Carcinoma in situ
Cisterna Chyli
A lymphatic sac at L1 to L2 receiving the intestinal and lumbar lymph trunks
Clearance and Half-Life
Half-life depends on both clearance and volume of distribution
Cleft Lip Laterality Pattern
Usually strikes on the left, left is more often bereft
Cleft Lip Versus Cleft Palate Timing
Lip by six, palate by twelve
Clinical Examination Sequence
Inspection, palpation, percussion, auscultation
Cloacal Division and Imperforate Anus
The urorectal septum divides the cloaca into urogenital sinus in front and anorectal canal behind
Closing Capacity
The volume at which dependent small airways begin to close
Clotting Screen Patterns
PT tests the extrinsic pathway, APTT the intrinsic, both the common
CNB - Core Needle Biopsy
Core Needle Biopsy
CNS
Central nervous system
Co-oximetry and the Dyshaemoglobinaemias
A pulse oximeter reads two wavelengths and can be badly misled
Coagulation Cascade Pathways
Extrinsic measured by prothrombin time, intrinsic by APTT
Coarctation and Rib Notching
Collateral flow through enlarged posterior intercostal arteries erodes the lower rib borders
Cochlea Versus Vestibule Function
Cochlea for hearing, vestibule for the leaning
Cochlear and Vestibular Histology
Organ of Corti for hearing, maculae and cristae for balance
Coeliac Disease Histology
Villous atrophy, crypt hyperplasia and intraepithelial lymphocytosis
Coeliac Disease Physiology
Immune-mediated villous atrophy in the proximal small bowel
Coeliac Serology
Tissue transglutaminase IgA with a total IgA, on a gluten containing diet
Coeliac Trunk Branches
Left gastric, splenic and common hepatic arteries
Collagen Synthesis
Hydroxylation requires vitamin C, then glycosylation, triple helix formation and cross-linking
Collagen Types
Type I bone and skin, II cartilage, III reticular, IV basement membrane
Collateral Branch and the Lower Border
The main bundle lies in the costal groove above, but a collateral branch runs along the rib below
Collateral History
Essential whenever the patient cannot give a reliable account
Collateral Ligaments of the Knee
The medial collateral ligament resists valgus force; the lateral collateral ligament resists varus force
Colon Parts and Flexures
Caecum, ascending, transverse, descending and sigmoid colon, with hepatic and splenic flexures
Colonic Function
Absorbs water and electrolytes, ferments fibre, and stores faeces
Colonic Watershed Areas
Griffiths' point at the splenic flexure and Sudeck's point at the rectosigmoid junction
Colorectal Adenoma to Carcinoma Sequence
APC, then KRAS, then p53, accumulating over years
Colorectal Polyps
Neoplastic adenomas versus non-neoplastic polyps
Common Drug Interaction Mechanisms
Pharmacokinetic interactions alter concentration; pharmacodynamic interactions alter effect
Common Fibular Nerve Injury - Foot Drop
Foot drop with loss of dorsiflexion and eversion and sensory loss over the dorsum of the foot
Common Histological Stains
H and E for routine work, with special stains for specific components
Compartment Syndrome - The P's
Pain out of proportion, Pain on passive stretch, Paraesthesia, Pallor, Pulselessness, Paralysis
Compensation Rules
Predictable formulae reveal whether a second disorder is present
Complement System
Classical, alternative and lectin pathways converging on C3
Compliance Hysteresis
The lung follows a different path on inflation than on deflation
Conducting and Respiratory Zones
Generations 0 to 16 conduct air; generations 17 to 23 exchange gas
Conduction Velocity Order
Purkinje fastest, atrioventricular node slowest
Confusion Assessment
Delirium is acute and fluctuating with inattention; dementia is chronic and progressive
Congenital Diaphragmatic Hernia Sites
Bochdalek is Back and to the Left; Morgagni is anterior and to the right
Connective Tissue Components
Cells, fibres and ground substance
Consciousness and the Reticular Activating System
Arousal requires the brainstem reticular formation and at least one functioning hemisphere
Constipation Physiology
Slow transit, outlet obstruction or normal transit with hard stool
Constrictive Pericarditis Versus Tamponade
Kussmaul's sign and the y descent separate them
Contraception Mechanisms
Suppress ovulation, thicken mucus, or prevent implantation
Contractility Modifiers
Sympathetic drive and calcium raise it; hypoxia, acidosis and beta blockade lower it
Contrast Media Cautions
Renal function, allergy, thyroid and metformin
Contrast-Induced Nephropathy
Medullary vasoconstriction and direct tubular toxicity
Cooper's Ligaments and Skin Dimpling
Fibrous septa from the dermis to the pectoral fascia that tether the breast
COP - Cryptogenic Organising Pneumonia
Cryptogenic Organising Pneumonia
COPD
Chronic obstructive pulmonary disease
COPD Diagnosis and Staging
Post-bronchodilator FEV1/FVC below 0.7, staged by FEV1
COPD Exacerbation Management
Controlled oxygen, bronchodilators, steroids, and antibiotics if infected
COPD Physiology
Loss of elastic recoil, airway collapse, gas trapping and impaired gas exchange
Coracoid Process Attachments
Pectoralis minor, Coracobrachialis, short head of Biceps brachii
Cori and Alanine Cycles
Cori cycle carries lactate; the alanine cycle also carries nitrogen
Cornea Layers
Epithelium, Bowman layer, stroma, Descemet membrane, endothelium
Corneal Reflex Pathway
Touch with five, blink with seven
Coronary Artery Dominance
Dominance is decided by whichever artery gives the posterior descending branch, the right in about 85 per cent
Coronary Blood Flow Regulation
Local metabolic factors dominate, especially adenosine and hypoxia
Coronary Perfusion Happens in Diastole
The left coronary artery fills in diastole, when the myocardium is relaxed
Coronary Sinus Tributaries
Great, middle and small cardiac veins, posterior vein of the left ventricle and the oblique vein of the left atrium
Coronary Steal
Dilating already maximally dilated vessels diverts flow away from ischaemic territory
Corrugator Supercilii Frown Line
Corrugator draws the brows together, a furrowed frown in any weather
Cortical Sensory Homunculus
Body parts are represented in proportion to innervation density, not size
Corticosteroid Equivalence and Effects
Differing glucocorticoid and mineralocorticoid potency between agents
Cortisol Actions
Raises glucose, breaks down protein and fat, suppresses immunity, and maintains vascular tone
Cortisol Deficiency and Adrenal Crisis
Hypotension, hyponatraemia, hyperkalaemia and hypoglycaemia
Costal Margin and Subcostal Angle
Formed by the cartilages of ribs 7 to 10, meeting at the xiphisternum
Costovertebral and Costotransverse Joints
The head articulates with two vertebral bodies; the tubercle articulates with one transverse process
Cough Reflex
Inspiration, glottic closure, compression, then explosive expiration
Couinaud Liver Segments
Eight segments, each with its own portal inflow and biliary drainage
Countercurrent Exchanger
Hairpin capillaries preserve the medullary gradient while still supplying blood
Countercurrent Multiplier
The ascending limb pumps out salt, the descending limb loses water, and the gradient multiplies
Courvoisier's Law
A palpable gallbladder with painless jaundice is unlikely to be due to stones
CPR
Cardiopulmonary resuscitation
Cranial Nerve Functions
Some Say Marry Money But My Brother Says Big Brains Matter More
Cranial Nerve I Bedside Test
Sniff for one, smell tells if the first is gone
Cranial Nerve II Bedside Test
See for two, visual acuity and fields come through
Cranial Nerve IX Bedside Test
Gag reflex afferent, posterior tongue taste and palatal sensation
Cranial Nerve Nuclei by Brainstem Level
Three and four live up top, five six seven eight bunk together in the pons, nine through twelve settle low
Cranial Nerve Order I to XII
Oh Oh Oh To Touch And Feel Very Green Vegetables AH
Cranial Nerve Reflexes
Each reflex pairs a sensory nerve with a motor nerve
Cranial Nerve Sensory Motor or Both
Some Say Marry Money But My Brother Says Big Brains Matter More
Cranial Nerve V Motor Bedside Test
Clench for five, feel the masseter come alive
Cranial Nerve V Sensory Bedside Test
Three divisions tested separately, plus the corneal reflex
Cranial Nerve VII Bedside Test
Smile, puff, frown for seven, raise your brows up toward heaven
Cranial Nerve VIII Bedside Test
Whisper test, tuning forks, then the vestibular tests
Cranial Nerve X Bedside Test
Say ah for ten, watch the uvula pull, then
Cranial Nerve XI Bedside Test
Shrug and turn for eleven, against resistance, push like Kevin
Cranial Nerve XII Bedside Test
Stick out for twelve, tongue points toward the weaker shelf
Cranial nerves clean mnemonic
Oh Once One Takes The Anatomy Final, Very Good Vacations Are Heavenly
Cranial Nerves III, IV and VI Bedside Test
Eye movements, pupils, lids and diplopia together
CRC
Colorectal cancer
Creatinine as a Marker of GFR
Creatinine rises only after substantial loss of filtration, and depends on muscle mass
Cremasteric Reflex
L1 and L2, afferent by the ilioinguinal nerve and efferent by the genitofemoral
Cricoarytenoid Joint Movement Type
Rotates and slides like a knob on a dial, opens and closes the cords all the while
Cricoid Cartilage Vertebral Level
Cricoid sits at C6, where the airway becomes the trachea and the oesophagus truly begins
Cricothyroid Joint Movement Type
Tilts and rocks like a see-saw plank, tenses the cords as it cranks
Cricothyroid Membrane Location
Between the shield and the ring
Cricothyroidotomy Landmark
Feel the notch between shield and ring, that's the emergency door
Croup Versus Epiglottitis
Croup barks and is gradual; epiglottitis drools and is sudden
CRP
C-reactive protein
Cruciate Ligaments - Named by the Tibia
The ACL stops the tibia sliding forward; the PCL stops the tibia sliding backward
CSF Rhinorrhoea Halo Test
A halo ring on gauze or sheet, CSF mixed with blood, a telltale feat
CT - Computed Tomography
Computed Tomography
CT Head Indications After Injury
Immediate scanning criteria and the one hour and eight hour rules
CTA - CT Angiogram
CT Angiogram
CTC - CT Colonoscopy
CT Colonoscopy
CTDIvol - CT Dose Index Volume
CT Dose Index Volume
CTPA - CT Pulmonary Angiogram
CT Pulmonary Angiogram
Cullen's and Grey Turner's Signs
Cullen's is periumbilical bruising; Grey Turner's is flank bruising
CURB-65 Score
Confusion, Urea, Respiratory rate, Blood pressure, age 65
Cushing Reflex
Hypertension, bradycardia and irregular respiration
Cushing Syndrome Causes
ACTH dependent or independent, with exogenous steroids the commonest of all
Cutaneous Circulation and Thermoregulation
Arteriovenous anastomoses under sympathetic control dominate skin flow
Cutaneous Nerve Supply of the Hand
Median nerve lateral three and a half digits (palmar), Ulnar nerve medial one and a half digits, Radial nerve dorsolateral hand
CXR - Chest X-Ray
Chest X-Ray
Cyanotic Congenital Heart Disease
The five Ts, numbered by the great vessel count
Cystic Fibrosis Biochemistry
A defective chloride channel causes thick secretions in every exocrine organ
Cytochrome P450 Interactions
Inducers speed metabolism and reduce effect; inhibitors slow it and increase effect
Cytokines and Inflammation
Interleukin-1, interleukin-6 and tumour necrosis factor drive the acute phase response
Cytology Versus Histology
Cytology examines individual cells; histology examines tissue architecture
Cytoskeleton Components
Microfilaments, intermediate filaments and microtubules, in increasing size
Cytotoxic Drug Classes
Alkylating agents, antimetabolites, antitumour antibiotics and mitotic inhibitors
D-dimer Interpretation
A rule out test only, applied after a clinical probability score
DAI - Diffuse Axonal Injury
Diffuse Axonal Injury
Danger Triangle of the Face
Nose to the mouth's two corners, no valves, straight line to the cavernous sinus
DATES
Descending aorta, Azygos system, Thoracic duct, (o)Esophagus, Sympathetic chain
DCE - Dynamic Contrast-Enhanced
Dynamic Contrast-Enhanced
DCIS
Ductal carcinoma in situ
Dead Space Types
Physiological dead space equals anatomical plus alveolar dead space
Deciduous Tooth Eruption Span
Central first to bite, second molar ends the fight
DECT - Dual-Energy CT
Dual-Energy CT
Deep Cervical Fascia Layers
Investing, Pretracheal, Prevertebral, three coats around the neck
Deep Vein Thrombosis Assessment
Score first, then D-dimer or ultrasound accordingly
Defecation Reflex
Rectal distension triggers internal sphincter relaxation, with voluntary external sphincter control
Dehydration Assessment in Children
Clinical signs graded against percentage body weight loss
Delayed Onset Muscle Soreness
Microscopic damage from eccentric contraction, not lactate
Delirium Versus Dementia
Onset, course, attention and consciousness separate them
Deltoid Parts and Actions
Anterior fibres flex and medially rotate, middle fibres abduct, posterior fibres extend and laterally rotate
Dementia Drug Therapy
Cholinesterase inhibitors first, memantine second
Depression Screening
SIGECAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide
Dermis Structure
Papillary dermis is fine and vascular; reticular dermis is dense and strong
Describing a Lump
Site, size, shape, surface, edge, consistency, mobility and more
Describing a Skin Lesion
Site, distribution, morphology, colour, border, surface and secondary change
Describing an Ulcer
Base, edge, depth, discharge, site and the surrounding skin
DESH - Disproportionately Enlarged Subarachnoid-space Hydrocephalus
Disproportionately Enlarged Subarachnoid-space Hydrocephalus
Determinants of Glomerular Filtration Rate
Afferent constriction lowers GFR; efferent constriction raises it
Developmental Dysplasia of the Hip Screening
Barlow dislocates, Ortolani relocates
DEXA - Dual-Energy X-Ray Absorptiometry
Dual-Energy X-Ray Absorptiometry
Dexamethasone Suppression Testing
Confirm cortisol excess, then localise with ACTH and high dose suppression
Diabetes Insipidus Types
Central lacks the hormone; nephrogenic cannot respond to it
Diabetes Mellitus Types
Type 1 is absolute insulin deficiency; type 2 is resistance with relative deficiency
Diabetic Foot Examination
Skin, deformity, neuropathy and circulation
Diabetic Ketoacidosis Management
Fluid first, then fixed rate insulin, watching the potassium
Diabetic Ketoacidosis Physiology
Insulin deficiency with counter-regulatory excess causes hyperglycaemia and ketogenesis
Diabetic Nephropathy
Hyperfiltration, then microalbuminuria, then proteinuria and decline
Diagnosing Diabetes
HbA1c, fasting glucose, random glucose and the tolerance test
Dialysis Principles
Diffusion for small solutes, convection for larger ones, ultrafiltration for water
Diaphragm Blood Supply
Pericardiacophrenic, musculophrenic and superior phrenic arteries above; inferior phrenic arteries below
Diaphragm Development Components
Septum transversum, pleuroperitoneal membranes, dorsal mesentery of the oesophagus, and body wall
Diaphragm Muscular Origins
Sternal, costal and lumbar parts, all converging on the central tendon
DICOM - Digital Imaging and Communications in Medicine
Digital Imaging and Communications in Medicine
Diffusing Capacity
Measured with carbon monoxide, reflecting surface area, membrane thickness and haemoglobin
Digastric Muscle Bellies and Nerve Supply
Two bellies, one tendon sling, anterior chews forward, posterior pulls back
Digastric Nerve Supply Split by Belly
Anterior belly's fed by five, posterior by seven, one muscle, two masters driven
DiGeorge Syndrome Features
CATCH-22
Digital Rectal Examination
Inspect, then palpate the canal, rectum and prostate
Digoxin Toxicity
Nausea, confusion, yellow vision and arrhythmia, worsened by hypokalaemia
Dilator Naris Function
Dilator naris widens the door when you need more air to pour
Direct Antiglobulin Test
Direct detects antibody on the cells, indirect detects antibody in the plasma
Direct Versus Indirect Inguinal Hernia
Indirect passes lateral to the inferior epigastric vessels; direct pushes through medial to them
Disseminated Intravascular Coagulation
Widespread activation of coagulation consumes factors and platelets, causing both thrombosis and bleeding
Distinguishing Kidney from Spleen
You can get above a kidney and ballotte it; you cannot with a spleen
Diving Reflex
Bradycardia, peripheral vasoconstriction and splenic contraction
DLP - Dose-Length Product
Dose-Length Product
DNA Repair Mechanisms
Each pathway repairs a different kind of damage
DNA Replication
Semi-conservative, bidirectional, with leading and lagging strands
Dorsalis Pedis Pulse
On the dorsum of the foot, lateral to the extensor hallucis longus tendon
DRE - Dose Reference Level
Dose Reference Level
Drug and Allergy History
Prescribed, over the counter, herbal, recreational, and the allergy detail
Drug Induced Liver Injury
Hepatocellular, cholestatic or mixed; intrinsic or idiosyncratic
Drug Metabolism Phases
Phase I modifies the molecule; phase II conjugates it
Drug Receptor Families
Ion channels, G protein coupled, kinase linked and nuclear receptors
Drugs Causing Common Side Effects
Working backwards from the symptom to the likely drug
Drugs to Avoid in Pregnancy
Warfarin, retinoids, ACE inhibitors, valproate and tetracyclines among others
DSA - Digital Subtraction Angiography
Digital Subtraction Angiography
DTI - Diffusion Tensor Imaging
Diffusion Tensor Imaging
Duodenum: Four Parts
Superior, descending, horizontal and ascending, 2, 8, 10 and 5 centimetres
Dural Venous Sinus Drainage Path
Sally Sees Cats Turn Sideways, Jumping
DVT - Deep Vein Thrombosis
Deep Vein Thrombosis
DWI - Diffusion-Weighted Imaging
Diffusion-Weighted Imaging
DWIBS - Diffusion-Weighted Imaging with Background Body Signal Suppression
Diffusion-Weighted Imaging with Background Body Signal Suppression
DXA - Dual-Energy X-Ray Absorptiometry
Dual-Energy X-Ray Absorptiometry
Dynamic Airway Compression
Beyond a certain effort, higher pleural pressure compresses airways and flow cannot increase
Dysphasia Versus Dysarthria
Language, articulation and voice are separate problems
Dysplasia and Carcinoma in Situ
Metaplasia, dysplasia, carcinoma in situ, then invasion
Ear Examination and Hearing Tests
Otoscopy, then Rinne and Weber to classify hearing loss
ECG / EKG
Electrocardiogram
ECG Lead Territories
II, III and aVF inferior; V1 to V4 anterior; I, aVL, V5 and V6 lateral
ECG Reading Sequence
Rate, rhythm, axis, intervals, then the waves in every lead
ECG Waves and Intervals
P atrial depolarisation, QRS ventricular depolarisation, T ventricular repolarisation
Echocardiography Views and Indications
Parasternal, apical and subcostal windows, transthoracic or transoesophageal
EDH - Extradural Haematoma
Extradural Haematoma
EDV - End-Diastolic Velocity
End-Diastolic Velocity
EF - Ejection Fraction
Ejection Fraction
eFAST - Extended FAST
Extended FAST
Effect of Calcium on the Heart
Hypercalcaemia shortens the QT interval; hypocalcaemia prolongs it
Effect of Potassium on the Heart
Hyperkalaemia gives tall T waves and a wide QRS; hypokalaemia gives flat T waves and U waves
Effects of Altitude on Respiration
Falling barometric pressure lowers inspired oxygen, driving hyperventilation and acclimatisation
Effects of Anaesthesia on Respiration
Reduced functional residual capacity, blunted drive, and atelectasis
Effects of Diuretics by Site
Acetazolamide proximal, loop diuretics in the loop, thiazides distal, potassium sparers in the collecting duct
Effects of Diving on Respiration
Pressure rises by one atmosphere for every 10 metres of seawater
Effects of Immobility
Muscle wasting, bone loss, orthostatic intolerance and thrombosis
Eicosanoid Synthesis
Cyclo-oxygenase makes prostaglandins; lipoxygenase makes leukotrienes
Eight Cranial Bones
Old People From Texas Eat Spiders Sometimes
Einthoven's Triangle
Three bipolar limb leads forming a triangle around the heart
Ejection Fraction
Stroke volume divided by end-diastolic volume, normally over 50 per cent
Elbow Joint Movements
The elbow is a hinge joint allowing only flexion and extension
Electrolyte Reference Ranges
The standard adult reference values for the basic metabolic panel
Electron Microscopy Uses
Renal biopsy, ciliary disorders, storage disease and undifferentiated tumours
Electron Transport Chain Complexes
Four complexes pumping protons, and ATP synthase using the gradient
Emissary Vein Function
Little bridges connect scalp veins to sinus deep, infection's secret sneak
Emphysema Types
Centriacinar from smoking, panacinar from alpha-1 antitrypsin deficiency
Empirical Antibiotic Choices
Site predicts organism, and organism predicts the antibiotic
End of the Bed Inspection
The patient, the bedside and the surroundings
Endometrial Cycle Histology
Proliferative under oestrogen, secretory under progesterone
Endothelium-Derived Mediators
Nitric oxide and prostacyclin dilate; endothelin and thromboxane constrict
Enteric Nervous Plexuses
Auerbach's myenteric plexus controls motility; Meissner's submucosal plexus controls secretion
Enteric Nervous System Control
Intrinsic enteric plexuses modulated by parasympathetic and sympathetic input
Enterohepatic Circulation
Bile salts are reabsorbed in the terminal ileum and returned to the liver by the portal vein
Enzyme Cofactors from Vitamins
Most B vitamins are coenzyme precursors for specific reaction types
Enzyme Inhibition Types
What happens to Km and Vmax distinguishes them
Enzyme Kinetics
Km reflects affinity and Vmax reflects capacity
Enzyme Markers of Tissue Damage
Each tissue releases a characteristic enzyme profile when damaged
Enzyme Regulation Mechanisms
Allosteric control, covalent modification, and changes in enzyme quantity
Epidermal Layers
Come Let's Get Sun Burnt: basale, spinosum, granulosum, lucidum, corneum
Epidural Versus Subdural Haemorrhage Shape
Epidural is a lens, subdural is a banana
Epiglottis Cartilage Type
Elastic, so it springs back into place, epiglottis bounces, doesn't lose face
Epiploic Foramen Boundaries
Portal triad in front, inferior vena cava behind, caudate lobe above, duodenum below
Epithelial Classification
Simple or stratified, then squamous, cuboidal or columnar
Epithelial Surface Specialisations
Microvilli, stereocilia and cilia, with different structure and function
Erb's Point and Cutaneous Nerves
Great auricular, lesser occipital, transverse cervical, supraclavicular, four nerves burst at the border
Erb's Versus Klumpke's Palsy
Erb's palsy is C5 to C6 (upper trunk); Klumpke's palsy is C8 to T1 (lower trunk)
ERCP - Endoscopic Retrograde Cholangiopancreatography
Endoscopic Retrograde Cholangiopancreatography
Erectile Physiology
Point and Shoot: parasympathetic for erection, sympathetic for emission
Erythrocyte and Platelet Morphology
Biconcave anucleate discs with central pallor, and anucleate platelet fragments
Erythropoietin
Produced by renal interstitial cells in response to hypoxia
ESR Versus CRP
CRP rises and falls fast; ESR is slow and influenced by many factors
Essential Amino Acids
PVT TIM HaLL: Phenylalanine, Valine, Threonine, Tryptophan, Isoleucine, Methionine, Histidine, Leucine, Lysine
Eustachian Tube Function
Opens to equalise, pops when you fly, blocks and your ear says goodbye
EVAR - Endovascular Aneurysm Repair
Endovascular Aneurysm Repair
Excitation-Contraction Coupling
Calcium entry triggers calcium release from the sarcoplasmic reticulum
Exercise Tolerance Testing
Graded exercise with continuous ECG, looking for ischaemic change
Exocrine Gland Classification
Classified by duct branching, secretory unit shape and mode of secretion
Explaining and Breaking Bad News
SPIKES: Setting, Perception, Invitation, Knowledge, Emotions, Strategy
External Carotid Artery Branches
Some Ladies Find Occlusion Painful, So They Make Out
External Ear Cartilage Landmarks
Helix wraps the whole way round, down to the lobe it's found
External Ear Hillock Development
Six hillocks of His fuse to build the outer ear's rise
External Jugular Vein Origin
Posterior auricular meets the back door of the retromandibular, external jugular is born
External Laryngeal Nerve Surgical Risk
Ties close to the superior thyroid vessels, injure it, lose your high notes
Extraocular Muscle Common Origin
Four recti spring from a common ring, the obliques do their own thing
Extraocular Muscle Innervation
LR6 SO4 rest 3
Extraocular Muscle Nerve Summary
Lateral rectus six, superior oblique four, everyone else reports to three
Extraocular Muscle Total Count
Six steer the eye, plus one lifts the lid, seven total, that's the bid
Eye Examination Sequence
Acuity, fields, pupils, movements, then the fundus
Eyelid Layers Front to Back
Skin Meets The Curtain
Eyelid Opener Versus Closer
Levator lifts, orbicularis shuts
F1 - F1 Score
F1 Score
Facial Artery Course
Climbs from the jaw, past the mouth's corner, up beside the nose, a winding road that shows
Facial Artery Pulse Points
Feel it at the jaw's angle and beside the nose, the facial artery's winding road
Facial Dermatome Division by Trigeminal Branch
V1 V2 V3 divide the face like slices of pie, forehead to chin
Facial Nerve Branches
Two Zebras Bit My Coccyx
Facial Nerve Palsy Localisation
Forehead sparing separates the two
Facial Nerve Segments Through the Temporal Bone
Labyrinthine, tympanic, mastoid, three segments bend like a Z through the ear
Facial Vein Valveless Risk
No valves means no one way street, infection can travel any way it please
Factors Impairing Wound Healing
Local factors at the wound, systemic factors in the patient
Falciform Ligament and the Bare Area
The bare area is the part of the liver in direct contact with the diaphragm
Falls Assessment
What happened, why, and what damage was done
Familial Hypercholesterolaemia
Very high cholesterol, tendon xanthomata and a family history of early death
FAST
Face, Arms, Speech, Time
FAST - Focused Assessment with Sonography in Trauma
Focused Assessment with Sonography in Trauma
Fat and Amniotic Fluid Embolism
Fat after long bone fracture, amniotic fluid around delivery
Fat Digestion and Absorption
Emulsification, lipolysis, micelle formation, absorption and chylomicron export
Fat Soluble Vitamins
ADEK: absorbed with fat, stored in the body, and capable of toxicity
Fatty Acid Classification
Saturated, monounsaturated and polyunsaturated, with omega-3 and omega-6 essential
Fatty Acid Oxidation
Carnitine shuttles long chain fatty acids into mitochondria for beta oxidation
Fatty Acid Synthesis
Cytoplasmic synthesis from acetyl-CoA using NADPH, with acetyl-CoA carboxylase rate limiting
FBC
Full blood count
FDG - Fluorodeoxyglucose
Fluorodeoxyglucose
Fed and Fasted States
Insulin dominates the fed state; glucagon and catecholamines dominate fasting
Femoral Canal Boundaries
Inguinal ligament in front, pectineal ligament behind, lacunar ligament medially, femoral vein laterally
Femoral Head Blood Supply
Mainly the medial circumflex femoral artery, with the lateral circumflex femoral and the artery of the ligamentum teres
Femoral Nerve Functions
Extends the knee, flexes the hip and supplies sensation to the anteromedial thigh and medial leg
Femoral Sheath and Canal
Lateral artery, middle vein and medial femoral canal with lymphatics
Femoral Triangle Borders - SAIL
Sartorius, Adductor Longus and the Inguinal Ligament
Femoral Versus Inguinal Hernia
Inguinal is above and medial to the pubic tubercle; femoral is below and lateral
Fertilisation and Implantation
Fertilisation in the ampulla, implantation about 6 to 10 days later
Fetal Circulation Physiology
The placenta is the organ of gas exchange, with three shunts bypassing liver and lungs
Fetal Circulation Shunts
Ductus venosus, foramen ovale, ductus arteriosus
Fetal Lung Fluid
Chloride-driven secretion in utero switches to sodium-driven absorption at birth
Fetal to Neonatal Circulatory Transition
The first breath drops pulmonary resistance and clamping the cord raises systemic resistance
Fetal Vascular Remnants
Ductus arteriosus becomes ligamentum arteriosum, ductus venosus becomes ligamentum venosum, umbilical vein becomes ligamentum teres
Fick Principle
Cardiac output equals oxygen consumption divided by the arteriovenous oxygen difference
Filtration Fraction
GFR divided by renal plasma flow, normally about 20 per cent
First Branchial Cleft Cyst Location
Near the ear, close to the parotid, a leftover groove, that's the plot to it
First Layer of the Sole
Abductor hallucis, Flexor digitorum brevis and Abductor digiti minimi
First Pass Metabolism
Drug absorbed from the gut passes through the liver before reaching the systemic circulation
First Rib Structures
Vein in front of the scalene tubercle, artery and lower trunk behind it
FLAIR - Fluid-Attenuated Inversion Recovery
Fluid-Attenuated Inversion Recovery
Fleischner - Fleischner Society
Fleischner Society
Flexor Retinaculum Attachments
Laterally the scaphoid and trapezium, medially the pisiform and hook of hamate
Floor of Mouth Muscle Sling
Mylohyoid makes the sling, geniohyoid sits above the string
Flow-Volume Loop Patterns
Scooped expiratory limb in obstruction; flattening indicates large airway obstruction
Fluid Choice Physiology
Crystalloids distribute by tonicity; colloids stay longer in the plasma
Fluid Status Assessment
History, observations, examination and charts together
fMRI - Functional MRI
Functional MRI
FNA - Fine Needle Aspiration
Fine Needle Aspiration
FNAC - Fine Needle Aspiration Cytology
Fine Needle Aspiration Cytology
Folate and Antifolate Drugs
Folate donates one carbon units for thymidine and purine synthesis
Fontanelle Positions and Closure
Big Diamond Front, Small Triangle Back
Foramen Lacerum Contents
Lacerum looks big but it's mostly filled, nothing much really gets through
Foramen Magnum Contents
The big hole carries the big stuff
Foramen Ovale Contents
OVAL door for the big jaw nerve
Foramen Rotundum Contents
ROUND hole, round cheek nerve
Foramen Spinosum Contents
Spiny needle brings the blood in
Foregut, Midgut and Hindgut Derivatives
Foregut to mid-duodenum, midgut to two-thirds of the transverse colon, hindgut to the upper rectum
Four Muscle Layers of the Sole
Four layers from superficial to deep, supplied by the medial and lateral plantar nerves
Four Parasympathetic Ganglia of the Head
Ciliary sees, pterygopalatine cries, otic chews, submandibular drools
Fourteen Facial Bones
Two Zygomatic Nasal Every Maxilla Loves Vomer, In Public
FOV - Field of View
Field of View
Fractional Excretion of Sodium
Below 1 per cent suggests prerenal; above 2 per cent suggests tubular injury
Fractional Exhaled Nitric Oxide
A marker of eosinophilic airway inflammation
Frank-Starling Law
The more the ventricle fills, the harder it contracts, within limits
Free Radical Injury
Unpaired electrons attacking lipids, proteins and DNA
Free Radicals and Antioxidants
Reactive oxygen species damage lipids, proteins and DNA unless neutralised
Free Water Clearance
The volume of solute-free water excreted or retained per unit time
Frey's Syndrome Mechanism
Sweat while you eat, parotid surgery crosses gustatory and sweat nerve fibres
Frontalis Muscle Attachment
Frontalis raises the brow in surprise, no bone beneath it, just skin that flies
Frozen Section Indications
Margins, tissue identification, and confirming malignancy during surgery
Fructose and Galactose Metabolism
Both enter glycolysis, and blocks in either pathway cause distinct disorders
Full Blood Count Interpretation
Three cell lines, then the indices, then the film
Functional Residual Capacity Determinants
The balance point where inward lung recoil equals outward chest wall recoil
Functions of the Kidney
A WET BED: Acid-base, Water, Electrolytes, Toxins, Blood pressure, Erythropoietin, vitamin D
G6PD Deficiency
Loss of NADPH leaves red cells defenceless against oxidative stress
Gag Reflex Pathway
Nine tastes it, ten gags it
Gait Abnormalities
Each gait points to a specific level of the nervous system
Gallbladder and Biliary Histology
Simple columnar epithelium with no muscularis mucosae or submucosa
Gallbladder Parts
Fundus, body, infundibulum and neck
Gallstone Ileus
A large stone erodes into the duodenum and impacts at the terminal ileum
GALS Screening Examination
Gait, Arms, Legs, Spine
Ganglia Histology
Dorsal root ganglion cells are large and regular; autonomic ganglion cells are smaller and scattered
Gastric Acid and Drug Absorption
Un-ionised drug is absorbed, so weak acids favour the stomach and weak bases the intestine
Gastric Carcinoma
Intestinal type from atrophic gastritis, diffuse type with signet ring cells
Gastric Emptying Control
Duodenal fat, acid, hypertonicity and protein all slow emptying
Gastric Gland Cell Types
Parietal cells make acid and intrinsic factor, chief cells make pepsinogen, G cells make gastrin
Gastric Lymphatic Drainage
Four main zones draining ultimately to the coeliac nodes
Gastric Mucosal Barrier
Mucus and bicarbonate layer, tight junctions, rapid turnover and good blood flow
Gastrocolic and Other Gut Reflexes
Gastrocolic, enterogastric, gastroileal and intestino-intestinal reflexes
Gastrointestinal Blood Supply and Ischaemia
Acute mesenteric ischaemia affects the small bowel; ischaemic colitis affects watershed colon
Gastrointestinal Hormones
Gastrin, secretin, cholecystokinin and GIP, each with a distinct trigger
GB - Gallbladder
Gallbladder
GCS
Glasgow Coma Scale
Gene Regulation
Transcriptional, post-transcriptional, translational and post-translational
General Anaesthetic Agents
Propofol for induction, volatile agents for maintenance
Genetic Inheritance Patterns
Dominant appears in every generation; recessive skips; X-linked spares father to son
Genetic Testing Methods
Resolution rises from whole chromosome to single base
GFR
Glomerular filtration rate
GGO - Ground Glass Opacity
Ground Glass Opacity
GH - Glenohumeral
Glenohumeral
GIST - Gastrointestinal Stromal Tumour
Gastrointestinal Stromal Tumour
Glasgow Coma Scale
Eyes out of 4, Verbal out of 5, Motor out of 6
Glial Cell Types
Astrocytes, oligodendrocytes, microglia and ependyma centrally; Schwann cells peripherally
Glomerular Filtration Barrier
Fenestrated endothelium, basement membrane, and podocyte foot processes
Glomerulonephritis Patterns
Proliferative, membranous, sclerosing and crescentic patterns
Glomerulotubular Balance
The proximal tubule reabsorbs a constant fraction of whatever is filtered
Glucagon and Counter-Regulation
Glucagon first, then adrenaline, then cortisol and growth hormone
Gluconeogenesis Bypass Reactions
Pyruvate carboxylase, PEP carboxykinase, fructose-1,6-bisphosphatase and glucose-6-phosphatase
Glucose Transport Maximum
Glucose appears in urine once plasma glucose exceeds about 10 mmol/l
Gluteus Maximus - Actions and Insertions
Extends and laterally rotates the hip, inserting into the iliotibial tract and the gluteal tuberosity
Glycogen Metabolism
Glycogen synthase builds; glycogen phosphorylase breaks down
Glycogen Storage Diseases
Von Gierke, Pompe, Cori and McArdle, by the organ affected
Glycolysis Overview
Ten steps converting glucose to two pyruvate, with a net gain of two ATP
GMax Extends, GMed Abducts
Gluteus maximus extends; gluteus medius/minimus abduct and stabilise the pelvis
Goblet Cells and Mucus
Unicellular mucous glands, increasing distally along the gut
Goodsall's Rule
Anterior openings track radially; posterior openings curve to the midline
Gram Stain Interpretation
Colour, shape and arrangement narrow the organism quickly
Granuloma Causes
Infection, foreign body, sarcoidosis, Crohn disease and vasculitis
Great Auricular Nerve Territory
Great auricular covers the ear and the angle of the jaw
Great Saphenous Vein Course
Runs in front of the medial malleolus up the medial leg to drain into the femoral vein
Great Vessel Origin Side Difference in the Neck
Right shares a trunk, left stands alone, straight off the arch it's grown
Greater and Lesser Sacs
The greater sac is the main cavity; the lesser sac lies behind the stomach
Greater Omentum
A four-layered apron hanging from the greater curvature of the stomach
Greater Petrosal Nerve Destination
The first branch off the facial, headed for the crying ganglion
Greater Sciatic Foramen Contents
Structures above and below piriformis as they leave the pelvis
Group and Save Versus Crossmatch
Group and save identifies the blood type; crossmatch reserves specific units
Growth Hormone Regulation
Pulsatile secretion controlled by GHRH and somatostatin, acting largely through IGF-1
Gut Microbiota Functions
Fermentation, vitamin synthesis, colonisation resistance and immune education
Gut Wall Layers
Mucosa, submucosa, muscularis externa and serosa or adventitia
Gut-Associated Lymphoid Tissue
Peyer's patches, M cells, lamina propria lymphocytes and secretory IgA
Guyon's Canal Contents
Ulnar nerve and ulnar artery
H-Test Eye Movement Pattern
Trace a big H in the air, that's how all six muscles show their care
H-Zone of the Face Danger
Nose to lip to eye, an H shaped tie, infections here risk the brain nearby
HA - Hepatic Artery
Hepatic Artery
Haem Synthesis and Porphyria
Begins and ends in the mitochondrion, with ALA synthase rate limiting
Haemoglobin Structure and Variants
Four globin chains each with a haem group; HbA is two alpha and two beta
Haemoglobinopathies
Sickle is a qualitative defect, thalassaemia a quantitative one
Haemolysis Investigation
Raised reticulocytes, bilirubin and LDH with low haptoglobin
Haemostasis Steps
Vasoconstriction, platelet plug, coagulation cascade, then fibrinolysis
Hair Follicle Structure and Cycle
Anagen growing, catagen regressing, telogen resting
Hallmarks of Cancer
Self-sufficiency in growth, evasion of death, limitless replication, angiogenesis, invasion and metastasis
Hamstrings cross hip and knee
True hamstrings cross both the hip and knee and are mainly supplied by the tibial division of the sciatic nerve
Hand Deformities in Nerve Palsy
Radial nerve wrist drop, ulnar nerve claw hand, median nerve hand of benediction or ape hand
Hand Examination
Look, feel, move and function, with characteristic deformity patterns
HbA1c
Glycated haemoglobin
HbA1c Interpretation
Reflects average glucose over the preceding 8 to 12 weeks
HCC - Hepatocellular Carcinoma
Hepatocellular Carcinoma
Hearing and the Auditory Pathway
Outer ear collects, middle ear amplifies, cochlea transduces by place coding
Heart Block Degrees
First degree long PR, second degree some dropped beats, third degree complete dissociation
Heart Failure Compensation
Sympathetic activation, renin-angiotensin activation, and ventricular remodelling
Heart Failure Drug Therapy
ACE inhibitor, beta blocker, mineralocorticoid antagonist and SGLT2 inhibitor
Heart Sounds
S1 atrioventricular valves close, S2 semilunar valves close, S3 rapid filling, S4 atrial contraction
Heart Surfaces and Chambers
Right ventricle anteriorly, left ventricle laterally, left atrium at the base
Heart Valve Cusp Names
Tricuspid has anterior, posterior and septal cusps; mitral has anterior and posterior
Heart Wall Layers
Endocardium, myocardium and epicardium, from inside out
Heat Illness
Central nervous system dysfunction defines heat stroke
Helicobacter Eradication Therapy
Triple therapy: a proton pump inhibitor plus two antibiotics for 7 days
Henderson-Hasselbalch Equation
pH depends on the ratio of bicarbonate to carbon dioxide, not their absolute values
Hepatic Portal Triad Zones
Zone 1 is periportal and best oxygenated; zone 3 is centrilobular and most vulnerable
Hepatitis B Serology
Surface antigen means infection, surface antibody means protection
Hepatorenal Syndrome Physiology
Splanchnic vasodilatation causes intense compensatory renal vasoconstriction
Hering-Breuer Reflexes
Inflation inhibits further inspiration; deflation stimulates it
Hernia Examination
Examine standing and lying, with a cough impulse and reducibility
Hiatus Hernia Types
Sliding hernia moves the junction upwards; rolling hernia keeps it in place
High Altitude Pulmonary Oedema
Uneven hypoxic pulmonary vasoconstriction overperfuses some capillaries
High Anion Gap Acidosis Causes
MUDPILES or GOLDMARK for the unmeasured anions
High Output States
Anaemia, pregnancy, thyrotoxicosis, sepsis, beriberi, Paget disease and arteriovenous fistula
Hilar Position on the Chest Radiograph
The left hilum is normally higher than the right, never lower
Hip Examination
Look, feel, move, with the Trendelenburg and Thomas tests
Hip Joint Ligaments
Iliofemoral, pubofemoral and ischiofemoral ligaments
Hip Joint Movements
Flexion, extension, abduction, adduction, medial rotation and lateral rotation
Hirschsprung Disease
Absent ganglion cells starting at the rectum and extending proximally, with the narrow segment being the abnormal one
HIV Testing and the Window Period
Fourth generation antigen and antibody test, negative from 45 days
HLA Disease Associations
Specific tissue types predisposing to specific autoimmune diseases
Hodgkin Versus Non-Hodgkin Lymphoma
Hodgkin has Reed-Sternberg cells and spreads contiguously; non-Hodgkin does not
Homocystinuria
Cystathionine beta synthase deficiency, resembling Marfan syndrome with thrombosis
Hormone Feedback Loops
Compare the trophic hormone with the target hormone to localise the lesion
Hormone Replacement Therapy
Oestrogen for symptoms, progestogen to protect the endometrium
Horner's Syndrome Triad
PAM, Ptosis Anhidrosis Miosis
Horseshoe Kidney and Renal Ascent
The kidney ascends from the pelvis to the lumbar region, and a fused lower pole is caught by the inferior mesenteric artery
HR
Heart rate
HRCT - High-Resolution CT
High-Resolution CT
HSG - Hysterosalpingogram
Hysterosalpingogram
HU - Hounsfield Unit
Hounsfield Unit
HV - Hepatic Vein
Hepatic Vein
Hyoid Bone Uniqueness
The only bone that touches no other bone, floats alone, on muscle sling it's grown
Hyoid Bone Vertebral Level
Hyoid sits at C3, feel it just below your chin
Hypercalcaemia Causes
Primary hyperparathyroidism and malignancy account for 90 per cent
Hyperkalaemia Management
Protect the heart, shift it in, then remove it
Hyperkalaemia Management Physiology
Stabilise the membrane, shift potassium into cells, then remove it from the body
Hyperosmolar Hyperglycaemic State
Extreme hyperglycaemia and dehydration without significant ketosis
Hyperprolactinaemia Causes
Physiological, pharmacological, pathological and the stalk effect
Hypersensitivity Pneumonitis
Organic dust exposure causing an immune reaction in the alveoli
Hypersensitivity Reactions
ACID: Anaphylactic, Cytotoxic, Immune complex, Delayed
Hypertension Pathophysiology
Raised cardiac output early, raised systemic vascular resistance later
Hypertensive Emergency
End organ damage, not the number, defines the emergency
Hyperventilation Syndrome
Respiratory alkalosis causes paraesthesiae, tetany and cerebral vasoconstriction
Hypocalcaemia Features
Neuromuscular irritability with tetany, Chvostek and Trousseau signs
Hypoglossal Canal Contents
Twelve has its own private door
Hypoglossal Nerve Palsy Sign
Tongue points toward the injured side, like it's pointing out the problem
Hypoglycaemia Management
Autonomic symptoms first, then neuroglycopenic
Hyponatraemia Assessment
Check osmolality, then volume status, then urine sodium
Hypothalamic Releasing Hormones
GnRH, TRH, CRH and GHRH stimulate; dopamine and somatostatin inhibit
Hypothenar Muscles - OAF of the Little Finger
Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi brevis
Hypothermia Management
Graded by core temperature, rewarmed according to severity
Hypoxic Pulmonary Vasoconstriction
Pulmonary arterioles constrict in hypoxia, diverting blood to better ventilated alveoli
Hypoxic Ventilatory Drive
Peripheral chemoreceptors respond only below about 8 kPa
I 8 10 Eggs At 12
IVC at T8, oesophagus at T10, aorta at T12
I, I Get Laid On Fridays
Iliohypogastric, Ilioinguinal, Genitofemoral, Lateral femoral cutaneous, Obturator, Femoral
ICA - Internal Carotid Artery
Internal Carotid Artery
ICC - Intraclass Correlation Coefficient
Intraclass Correlation Coefficient
IHC
Immunohistochemistry
IHD - Intrahepatic Duct
Intrahepatic Duct
Ileocaecal Valve
A one-way valve between ileum and caecum; a competent valve creates a closed loop
Ileus Physiology
Sympathetic overactivity, inflammation and opioids inhibit coordinated motility
Iliotibial Tract
Tensed by tensor fasciae latae and gluteus maximus, it stabilises the extended knee
Immune Related Adverse Events
Autoimmune inflammation of any organ, ending in -itis
Immunofluorescence Patterns
Linear, granular or absent, each indicating a mechanism
Immunoglobulin Classes
GAMED: IgG, IgA, IgM, IgE, IgD
Immunohistochemistry Markers
Antibodies against lineage-specific proteins identify a tumour's origin
Immunosuppressant Drugs
Steroids, calcineurin inhibitors, antimetabolites and biologics
Incidental Findings and Overdiagnosis
Incidentaloma, cascade and overdiagnosis
Incretin Effect
GLP-1 and GIP are released by the gut and amplify insulin secretion
Infarction Types
White infarcts in solid organs with a single supply; red infarcts in loose or dual-supplied tissue
Infective Endocarditis Pathology
Vegetations on damaged valves, with embolic and immune complications
Inferior Gluteal Nerve - Gluteus Maximus
Supplies gluteus maximus; injury causes difficulty rising, climbing and standing from sitting
Inferior Mesenteric Artery Branches
Left colic, sigmoid and superior rectal arteries
Inferior Vena Cava Tributaries
Formed at L5 by the common iliac veins, receiving lumbar, gonadal, renal, adrenal, phrenic and hepatic veins
Inflammatory Bowel Disease Drugs
Aminosalicylates, steroids, immunomodulators and biologics
Inflammatory Bowel Disease Histology
Transmural granulomatous inflammation versus mucosal crypt abscesses
Inflammatory Bowel Disease Physiology
Crohn is transmural and patchy anywhere; colitis is mucosal and continuous from the rectum
Infrahyoid Strap Muscles
Some Say Thyroid Often
Inguinal Ligament Derivatives
Lacunar and pectineal ligaments extend from the medial end of the inguinal ligament
Inherited Bleeding Disorders
Haemophilia bleeds into joints, von Willebrand from mucosa
Innate Versus Adaptive Immunity
Innate is immediate and non-specific; adaptive is slower, specific and has memory
Insulin Actions
Promotes storage of glucose, fat and protein, and drives potassium into cells
Insulin and Glucagon Regulation
Insulin stores in the fed state, glucagon mobilises in the fasted
Insulin Preparations
Rapid, short, intermediate and long acting, matched to basal and prandial needs
Insulin Signalling Pathway
A receptor tyrosine kinase acting through IRS and PI3K to recruit GLUT4
Intercostal Artery Origins
Posterior intercostals from the aorta; anterior intercostals from the internal thoracic and musculophrenic arteries
Intercostal Muscle Fibre Direction
External intercostals run downwards and forwards, like hands in pockets
Intercostal Nerve Branches
Collateral, lateral cutaneous and anterior cutaneous branches, plus rami communicantes
Internal Acoustic Meatus Contents
Seven and eight ride together through the internal gate
Internal Carotid Artery Segment Order
Cats Prowl Caves Carefully
Internal Jugular Vein Formation
Sigmoid sinus drops through the jugular foramen and becomes the vein
Internal Thoracic Artery Branches
Anterior intercostal, perforating and pericardiacophrenic branches, ending as superior epigastric and musculophrenic arteries
Interpreting Raised Alkaline Phosphatase
Liver, bone, placenta or gut, distinguished by GGT and clinical context
Interstitial Lung Disease by Zone
CHARTS for the upper zones, STAIR for the lower
Interstitial Lung Disease Patterns
Upper zone and lower zone causes have distinct differentials
Interventricular Septum Parts
A large muscular part and a small membranous part
Intestinal Fluid Balance
About 9 litres enters the gut daily and only 100 ml is lost in stool
Intracellular Accumulations
Lipid, protein, glycogen and pigments
Intracranial Haemorrhage Types
Extradural, subdural, subarachnoid and intracerebral, each with a characteristic vessel and shape
Intussusception
One segment of bowel telescopes into the next, most often ileocolic
IPF - Idiopathic Pulmonary Fibrosis
Idiopathic Pulmonary Fibrosis
IPMN - Intraductal Papillary Mucinous Neoplasm
Intraductal Papillary Mucinous Neoplasm
IR - Interventional Radiology
Interventional Radiology
Iron Absorption
Absorbed in the duodenum, controlled by hepcidin acting on ferroportin
Iron Studies Interpretation
Ferritin low in deficiency, normal or high in chronic disease
Ischaemia Reperfusion Injury
Oxygen returns to injured tissue and generates free radicals
Ischaemic Cascade
Perfusion falls, then metabolism, then diastolic and systolic function, then ECG changes, then pain
Ischioanal Fossa
A wedge-shaped space between the anal canal and the ischium, containing fat and the pudendal canal
Isoenzymes
Different molecular forms of the same enzyme, characteristic of different tissues
IVC - Inferior Vena Cava
Inferior Vena Cava
IVD - Intervertebral Disc
Intervertebral Disc
IVP - Intravenous Pyelogram
Intravenous Pyelogram
IVU - Intravenous Urogram
Intravenous Urogram
JACCOL
Jaundice, Anaemia, Clubbing, Cyanosis, Oedema, Lymphadenopathy
Jaundice, Pallor and Cyanosis
Sclera, conjunctiva, tongue and fingers
Jaw Jerk Reflex Pathway
Five in, five out, the only reflex that's all trigeminal about
Jejunum Versus Ileum
Jejunum is thicker walled with long vasa recta and few arcades; ileum is thinner with short vasa recta and many arcades
Joint and Cartilage Physiology
Avascular, aneural cartilage nourished by synovial fluid
Joint Examination Structure
Look, feel, move, then special tests and function
Jugular Foramen Contents
Jugular Vein Attracts Girls
Jugular Foramen Nerve Trio
Nine, Ten, Eleven ride the jugular bus, sitting right next to the vein
Juxtaglomerular Apparatus
Macula densa, juxtaglomerular cells and extraglomerular mesangial cells
Juxtaglomerular Apparatus Histology
Macula densa, granular cells and extraglomerular mesangium
JVP
Jugular venous pressure
JVP Waveform
a, c and v waves with x and y descents
Kappa - Cohen's Kappa
Cohen's Kappa
Keloid Versus Hypertrophic Scar
Keloid grows beyond the wound; hypertrophic stays within it
Ketone Body Metabolism
Made in the liver from acetyl-CoA, used by brain, heart and muscle
Kidney Position
From T12 to L3, with the right kidney lying lower than the left
Knee Bursae - Housemaid's and Clergyman's Knee
Prepatellar bursitis is housemaid's knee; infrapatellar bursitis is clergyman's knee
Knee Examination
Look, feel, move, then ligament and meniscal tests
Knee Joint Movements and the Screw-Home Mechanism
Flexion and extension, with rotation possible only when the knee is flexed
Knee Menisci - Medial Versus Lateral
The medial meniscus is C-shaped and fixed; the lateral is more circular and mobile
Knee Unhappy Triad
Anterior cruciate ligament, medial collateral ligament and medial meniscus
Korotkoff Sounds
Phase 1 gives systolic pressure and phase 5 gives diastolic
Krebs Cycle Overview
Acetyl-CoA is oxidised, generating NADH, FADH2 and GTP
KUB - Kidneys, Ureters, Bladder
Kidneys, Ureters, Bladder
L1 - Lumbar vertebra 1
Lumbar vertebra 1
L2 - Lumbar vertebra 2
Lumbar vertebra 2
L5 - Lumbar vertebra 5
Lumbar vertebra 5
Labour Physiology
Cervical dilatation, delivery of the fetus, then delivery of the placenta
Lacrimal Apparatus Flow Direction
Gland weeps above, punctum sips at the inner corner, sac drains down the duct, nose catches the run
Lactate Interpretation
Type A from hypoperfusion, type B without it
Lactation Physiology
Prolactin makes milk; oxytocin ejects it
Lactic Acidosis Types
Type A from hypoperfusion, type B without hypoxia
Laminar Versus Turbulent Flow
Reynolds number over about 2000 predicts turbulence
Large Bowel Features
Taeniae coli, haustra and appendices epiploicae
LARP
Left Anterior, Right Posterior
Laryngeal Cartilage Group
Those Cats Are Eating
Laryngeal Inlet Boundaries
Front flap, back peaks, side folds seal the leaks
Laryngopharynx Boundaries
From the epiglottis down to the cricoid's ring, food passes safely past the airway's wing
LAT - Lateral
Lateral
Lateral Cord Branches - LLM
Lateral pectoral nerve, Lateral root of the median nerve, Musculocutaneous nerve
Lateral Leg Compartment
Fibularis longus and fibularis brevis, supplied by the superficial fibular nerve
Lateral Pterygoid Protrusion Action
Lateral pterygoids pull it open, working as a pair
Latissimus Dorsi Actions
Extension, adduction and medial rotation of the arm, supplied by the thoracodorsal nerve
Law of Laplace in the Heart
Wall stress equals pressure times radius divided by twice the wall thickness
Laxative Classes
Bulk, osmotic, stimulant and softening agents
LCL - Lateral Collateral Ligament
Lateral Collateral Ligament
LDCT - Low-Dose CT
Low-Dose CT
LDH
Lactate dehydrogenase
Left Brachiocephalic Vein Course
It crosses the midline behind the manubrium to reach the superior vena cava
Left Coronary Artery Branches
Left anterior descending and circumflex arteries
Left Lung Segments
Apicoposterior, anterior, superior and inferior lingular; superior and three or four basal segments
Left Varicocele
The left testicular vein drains at a right angle into the left renal vein
Left Ventricle Features
Thick wall, fine trabeculae carneae, two papillary muscles, no moderator band
Left Versus Right Heart Failure
Left failure causes pulmonary congestion; right failure causes systemic congestion
Length-Tension and Force-Velocity Relationships
Force is greatest at optimal length and falls as shortening velocity rises
Lesser Omentum Parts
Hepatogastric and hepatoduodenal ligaments
Lesser Sciatic Foramen Contents
Pudendal nerve, internal pudendal vessels, nerve to obturator internus and the tendon of obturator internus
Leukaemia Classification
ALL in children, AML in adults, CLL in the elderly, CML in middle age
Levator Palpebrae Superioris Origin
Lifts from the back of the orbit, a short straight climb to the lid it'll orbit
LI-RADS - Liver Imaging Reporting and Data System
Liver Imaging Reporting and Data System
Ligament of Treitz
A fibromuscular band suspending the duodenojejunal flexure from the right crus of the diaphragm
Line of Brödel
A longitudinal plane about 1 cm behind the lateral convex border, between the anterior and posterior arterial divisions
Lines and Tubes on the Chest Radiograph
Every device has a correct position and a characteristic malposition
Lipolysis and Fatty Acid Transport
Hormone sensitive lipase releases it, albumin carries it, carnitine admits it
Lithium Monitoring
A narrow therapeutic index drug requiring regular level, renal and thyroid monitoring
Little's Area and Epistaxis
Five vessels kiss at the front of the septum
Liver and Pancreas Histology
Hepatic lobules with portal triads, and pancreatic acini with islets
Liver Dual Blood Supply
Portal vein gives 75 per cent of flow, hepatic artery gives 50 per cent of oxygen
Liver Enzyme Patterns
Transaminases versus alkaline phosphatase and gamma GT
Liver Function Tests
Transaminases indicate hepatocellular injury; ALP and GGT indicate cholestasis
Liver Functions
Synthesis, storage, metabolism, detoxification, excretion and immune function
Liver Injury Patterns
Steatosis, hepatitis, cholestasis, fibrosis and cirrhosis
Liver Ligaments
Falciform, coronary, triangular and round ligaments, plus the ligamentum venosum
Liver Sinusoids and the Space of Disse
Fenestrated endothelium, Kupffer cells and stellate cells
Liver Surface Markings
Upper border at the fifth intercostal space, lower border at the right costal margin
LLL - Left Lower Lobe
Left Lower Lobe
LOAF
Lateral two lumbricals, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis
LOC - Loss of Cortical Outline
Loss of Cortical Outline
Local Anaesthetic Mechanism
Block voltage-gated sodium channels from the inside of the axon
Local Anaesthetic Toxicity
Perioral tingling and tinnitus first, then seizures and cardiac arrest
Local Metabolic Vasodilators
Adenosine, carbon dioxide, hydrogen and potassium ions, and hypoxia
Long Head Origins - Supraglenoid and Infraglenoid
Long head of biceps from the supraglenoid tubercle, long head of triceps from the infraglenoid tubercle
Lower Limb Dermatome Landmarks
L4 medial leg, L5 dorsum of the foot and big toe, S1 lateral foot and little toe
Lower Limb Pulses
Femoral, popliteal, posterior tibial and dorsalis pedis pulses
Lower Limb Reflex Roots - Buckle My Shoe
Knee jerk L3 to L4, ankle jerk S1 to S2
Lower Oesophageal Sphincter Mechanisms
Right crus sling, angle of His, abdominal segment, mucosal rosette and the phreno-oesophageal ligament
LR6 SO4 AO3
Lateral rectus CN VI, superior oblique CN IV, all others CN III
Ludwig's Angina Airway Risk
Tongue goes up, airway's stuck
LUL - Left Upper Lobe
Left Upper Lobe
Lumbar Triangles and Hernias
Petit's inferior triangle and Grynfeltt's superior triangle
Lumbrical Nerve Supply - Lateral Two, Medial Two
Lateral two lumbricals by the median nerve, medial two by the ulnar nerve
Lung Cancer Presentation
Local invasion, distant spread and hormone secretion
Lung Cancer Types
Small cell is central and rapidly metastasising; non-small cell divides into squamous, adeno and large cell
Lung Capacities
A capacity is two or more volumes added together
Lung Compliance
Change in volume per unit change in pressure, determined by elastic tissue and surface tension
Lung Development Stages
Embryonic, Pseudoglandular, Canalicular, Saccular, Alveolar
Lung Hilum Structures
Pulmonary vein anterior and inferior, pulmonary artery next, bronchus posterior
Lung Lobes and Fissures
Right lung has three lobes and two fissures; left lung has two lobes and one fissure
Lung Lymphatic Drainage
Pulmonary, bronchopulmonary, tracheobronchial, then paratracheal nodes
Lung Mediastinal Impressions
Right lung is grooved by the azygos vein and superior vena cava; the left by the aortic arch and descending aorta
Lung Volumes - VATIRE
Volume, Air, Tidal, Inspiratory, Residual, Expiratory
Lung Volumes and Capacities
Four volumes combining into four capacities
Lung-RADS - Lung CT Screening Reporting and Data System
Lung CT Screening Reporting and Data System
LVEF - Left Ventricular Ejection Fraction
Left Ventricular Ejection Fraction
Lymph Node Examination
Site, size, consistency, tenderness, fixation and the drainage area
Lymph Node Structure
Cortex with follicles, paracortex with T cells, and medulla with plasma cells
Lymphatic System Functions
Returns interstitial fluid and protein, absorbs fat, and carries immune cells
Lymphatic Vessel Structure
Blind ended, highly permeable, with valves and no basement membrane
Lysosomal Storage Disorders
Enzyme deficiency causes substrate accumulation within lysosomes
Magnesium Physiology
A cofactor for ATP-dependent enzymes and a natural calcium antagonist
Maintenance Fluid Requirements
About 25 to 30 ml/kg/day of water with 1 mmol/kg each of sodium and potassium
Major Haemorrhage Protocol
Blood early, in balanced ratios, with tranexamic acid
Malabsorption Investigation
Luminal, mucosal or postmucosal failure
Male Reproductive Hormones
LH acts on Leydig cells for testosterone; FSH acts on Sertoli cells for spermatogenesis
Malignant Hyperthermia
Uncontrolled calcium release causes sustained contraction and hypermetabolism
MALT
Muscle Above, Aponeurosis Anterior, Ligament below, Transversalis fascia behind, 2 Ms, 2 As, 2 Ls, 2 Ts
Mandibular Nerve Branches
BLIA runs the lower jaw
Mandibular Nerve Exit Point
Three goes oval, the big jaw needs the big oval door
Marginal Artery of Drummond
A continuous anastomotic channel along the mesenteric border of the colon
MARMU
Musculocutaneous, Axillary, Radial, Median, Ulnar
Mast Cells and Histamine
Granulated connective tissue cells releasing histamine on IgE cross-linking
Mastoiditis Spread Route
Infection spreads through the mastoid air cells straight to the brain's back door
Maxillary Nerve Branches
ZIPS across the midface
Maxillary Nerve Exit Point
Two goes round, matches its round cheek
MCA - Middle Cerebral Artery
Middle Cerebral Artery
McBurney's Point
Two-thirds of the way along a line from the umbilicus to the right anterior superior iliac spine
MCC - Matthews Correlation Coefficient
Matthews Correlation Coefficient
MCL - Medial Collateral Ligament
Medial Collateral Ligament
Mean Arterial Pressure
Diastolic pressure plus one third of the pulse pressure
Measurement of Fluid Compartments
Deuterium for total body water, inulin for extracellular fluid, albumin for plasma
Mechanisms of Diarrhoea
Osmotic, secretory, inflammatory and motility related
Meckel's Cave Contents
Trigeminal ganglion rests in Meckel's cave, like a nerve tucked safe
Meckel's Diverticulum: Rule of Twos
2 per cent, 2 feet from the ileocaecal valve, 2 inches long, 2 types of ectopic tissue, under 2 years
Medial and Lateral Plantar Nerves
The medial plantar nerve behaves like the median nerve and the lateral plantar nerve like the ulnar nerve
Medial Cord Branches - Most Medical Men Use Morphine
Medial pectoral nerve, Medial cutaneous nerve of the arm, Medial cutaneous nerve of the forearm, Ulnar nerve, Medial root of the median nerve
Medial Thigh Compartment - The Adductors
Adductor longus, brevis and magnus, gracilis, pectineus and obturator externus, supplied by the obturator nerve
Median Nerve Lesion - Hand of Benediction
Hand of benediction, ape hand and loss of thumb opposition
Mediastinal Divisions
Superior mediastinum above the sternal angle; anterior, middle and posterior below it
Mediastinal Shift Direction
Pushed away by extra volume, pulled towards by lost volume
Memory Systems
Declarative memory needs the hippocampus; procedural memory does not
Meningeal Layers Outside to Inside
Dumb Aunts Party
Meninges Histology
Dense fibrous dura, avascular arachnoid, delicate vascular pia
Meningococcal Sepsis
A non-blanching rash in an unwell patient is meningococcal until proven otherwise
Menopause Physiology
Ovarian follicle depletion causes low oestrogen with high FSH and LH
Menstrual Cycle Phases
Follicular phase, ovulation at the LH surge, then a fixed 14-day luteal phase
Mental State Examination
Appearance, behaviour, speech, mood, thought, perception, cognition, insight
Mental State Examination Structure
ASEPTIC: Appearance, Speech, Emotion, Perception, Thought, Insight, Cognition
Mentalis Muscle Chin Action
Mentalis wrinkles the chin like a golf ball skin
Metabolic Alkalosis Maintenance
Generation is one thing; maintenance requires impaired bicarbonate excretion
Metaplasia Sites
One differentiated epithelium replaced by another better suited to the stress
Metopic Suture Early Fusion
The forgotten suture, fuses early, by age two it's gone from view
MI
Myocardial infarction
Micturition Reflex
Parasympathetic S2 to S4 empties the bladder; sympathetic and somatic control storage
Middle Cranial Fossa Contents
Temporal and pituitary's nest, cavernous sinus at the side of the crest
Middle Ear Cavity Walls
Roof Floor Front Back In Out, six walls about
Middle Mediastinum Contents
Heart and pericardium, roots of the great vessels, main bronchi, phrenic nerves
Midgut Rotation
Herniates at week 6, rotates 270 degrees anticlockwise, returns by week 10
Migrating Motor Complex
Cyclical waves of contraction every 90 to 120 minutes between meals
Milk Line and Accessory Breast Tissue
Along the mammary ridge, running from the axilla to the groin
MinIP - Minimum Intensity Projection
Minimum Intensity Projection
Minute Ventilation Versus Alveolar Ventilation
Minute ventilation includes dead space; alveolar ventilation does not
MIP - Maximum Intensity Projection
Maximum Intensity Projection
Mitochondrial Disorders
Maternally inherited, affecting the most energy dependent tissues
Mitosis Stages
PMAT: Prophase, Metaphase, Anaphase, Telophase
Mitral Stenosis Features
A mid-diastolic murmur with an opening snap, almost always rheumatic
Mobile Wad of Three
Brachioradialis, Extensor carpi radialis longus, Extensor carpi radialis brevis
Modes of Glandular Secretion
Merocrine, apocrine and holocrine, by how much cell is lost
Molecular Tumour Testing
Testing that determines which targeted treatment will work
Monoclonal Antibody Nomenclature
The suffix tells you the source, the syllable before it the target
Monro-Kellie Doctrine
Brain, blood and cerebrospinal fluid occupy a fixed volume within a rigid skull
Morison's Pouch
The hepatorenal recess, the lowest part of the peritoneal cavity in the supine patient
Motor Unit Recruitment
Recruitment of more units and increased firing rate, following the size principle
Motor Versus Sensory Nuclei Position
Motor nuclei sit medial, sensory nuclei sit lateral
Mouth and Throat Examination
Lips, mucosa, tongue, teeth, palate and tonsils, with a good light
MPR - Multiplanar Reconstruction
Multiplanar Reconstruction
MRA - MR Angiography
MR Angiography
MRCP - MR Cholangiopancreatography
MR Cholangiopancreatography
mRECIST - Modified RECIST
Modified RECIST
MRI - Magnetic Resonance Imaging
Magnetic Resonance Imaging
MRS - MR Spectroscopy
MR Spectroscopy
MRSpec - MR Spectroscopy
MR Spectroscopy
MS - Multiple Sclerosis
Multiple Sclerosis
MSK - Musculoskeletal
Musculoskeletal
Mucociliary Clearance
Cilia beat in a watery sol layer, moving an overlying gel layer of mucus upwards
Mucosa Layers
Epithelium, lamina propria and muscularis mucosae
Multiple Endocrine Neoplasia
MEN1 is three Ps; MEN2A is two Cs and a P; MEN2B adds mucosal neuromas
Murmur Description
SCRIPT: Site, Character, Radiation, Intensity, Pitch, Timing
Murmur Timing
Systolic murmurs come from stenotic outflow or leaking inflow valves, and diastolic murmurs the reverse
Murphy's Sign
Arrest of inspiration on palpating the right upper quadrant, from an inflamed gallbladder meeting the examining hand
Muscle Energy Systems
Phosphocreatine for seconds, glycolysis for minutes, oxidative for hours
Muscle Fatigue Mechanisms
Central and peripheral mechanisms, with metabolite accumulation and substrate depletion
Muscle Spindle and Stretch Reflex
Spindles sense length and drive the monosynaptic stretch reflex
Muscles of Mastication Count
Some Muscles Make You Munch
Muscles of Mastication That Close the Jaw
My Try Might Ache
Muscles of Respiration
The diaphragm alone at rest, with accessory muscles for forced inspiration and abdominals for forced expiration
Muscles That Depress and Retract the Mandible
Temporalis pulls it back, gravity does the rest of the opening act
Mutation Types
Silent, missense, nonsense and frameshift, in order of severity
MWA - Microwave Ablation
Microwave Ablation
Myelination Structure
Concentric wrapping of plasma membrane with nodes of Ranvier between
Myeloma Features
CRAB: Calcium raised, Renal failure, Anaemia, Bone lesions
Myeloproliferative Neoplasms
Polycythaemia vera, essential thrombocythaemia, myelofibrosis and CML
Myocardial Infarction Timeline
Coagulative necrosis, then neutrophils, macrophages, granulation tissue and scar
Myocardial Oxygen Demand
Heart rate, contractility and wall stress
Myocardial Stunning and Hibernation
Stunning follows restored flow; hibernation persists with reduced flow
Myocarditis
Inflammation of the myocardium, usually viral, often mimicking infarction
Myopectineal Orifice
The area of Fruchaud, bounded by rectus, the oblique muscles, the iliopubic tract and the pubic ramus
Myxoedema Coma
Hypothermia, hypoventilation, hyponatraemia and reduced consciousness
NAD - No Abnormality Detected
No Abnormality Detected
NAD+
Nicotinamide adenine dinucleotide
Nail Signs
Clubbing, koilonychia, leuconychia, splinter haemorrhages and pitting
Narrow Versus Broad Complex Tachycardia
Width tells you where it starts, regularity tells you which one
Nasal Cavity Arterial Supply Summary
A five way kiss at Kiesselbach's
Nasal Septum Building Blocks
Plate on top, Vomer below, Cartilage in front
Nasalis Muscle Action
Nasalis flares the nostrils wide, compressor and dilator riding side by side
Nasopharynx Boundaries
Behind the nose, above the palate, a passage that connects but does not halt it
Natriuretic Peptides
Released by stretched myocardium; they oppose the renin-angiotensin system
Nausea and Vomiting of Pregnancy
Progesterone relaxes smooth muscle, slowing emptying and reducing sphincter tone
NAVEL
Nerve, Artery, Vein, Empty space, Lymphatics
Neck Lump Assessment
Position, movement and age narrow the differential rapidly
NECT - Non-Enhanced CT
Non-Enhanced CT
Nephritic Versus Nephrotic Syndrome
Nephritic is inflammatory with haematuria; nephrotic is leaky with heavy proteinuria
Nephron Segment Functions - GLARCD
Glomerulus, Loop (of Henle), Ascending limb, Renal cortex collecting duct, Collecting Duct
Nephron Segments
Glomerulus, proximal tubule, loop of Henle, distal tubule, collecting duct
Nerve Fibre Classification
A alpha fastest, then A beta, A gamma, A delta, B and C slowest
Nerves at Risk in Axillary Dissection
Long thoracic, thoracodorsal and intercostobrachial nerves
Nerves of Latarjet
The terminal branches of the anterior and posterior vagal trunks supplying the pylorus
NET - Neuroendocrine Tumour
Neuroendocrine Tumour
Neurodegenerative Disease Pathology
Each disease has a characteristic misfolded protein and distribution
Neurogenic Shock
Hypotension with bradycardia and warm peripheries after high spinal cord injury
Neuroleptic Malignant Syndrome
FEVER: Fever, Encephalopathy, Vitals unstable, Elevated CK, Rigidity
Neuromuscular Junction Transmission
Acetylcholine acts on nicotinic receptors and is broken down by acetylcholinesterase
Neurone Structure and Types
Unipolar, bipolar and multipolar, with Nissl substance in the cell body
Neurotransmitter Synthesis from Amino Acids
Tyrosine gives catecholamines, tryptophan gives serotonin, glutamate gives GABA
Neurotransmitter Systems
Glutamate excites, GABA inhibits, and the monoamines modulate
Neurotransmitters in Autonomic Ganglia
Nicotinic at all ganglia, muscarinic and adrenergic at effector organs
Neurovascular Assessment of a Limb
The six Ps: pain, pallor, pulselessness, perishing cold, paraesthesia, paralysis
Neutrophil Function
Margination, rolling, adhesion, transmigration, chemotaxis, phagocytosis and killing
New York Heart Association Classification
Four classes, graded by the activity that causes symptoms
Newborn Examination
A head to toe screen performed within 72 hours of birth
Newborn Screening Conditions
Nine conditions in the UK programme, taken at day 5
Newer Diabetes Drug Classes
The tides and the flozins, with benefits beyond glucose
NEWS2 Scoring
Six physiological parameters plus supplemental oxygen
NFA - No Further Action
No Further Action
NI-RADS - Neck Imaging Reporting and Data System
Neck Imaging Reporting and Data System
Nine Abdominal Regions
Two vertical midclavicular lines and two horizontal planes give nine regions
Nitrate Mechanism
Nitric oxide donation causes venodilatation, reducing preload and wall stress
Nitrogen Balance
Intake minus loss, positive in growth and negative in catabolism
Nitrogen Washout and Absorption Atelectasis
Nitrogen splints alveoli open; replacing it with rapidly absorbed oxygen allows collapse
Non-invasive Ventilation Indications
CPAP for oxygenation, BiPAP for ventilation
Non-Respiratory Functions of the Lung
Filtration, metabolism, immune defence, acid-base balance and a blood reservoir
NPH - Normal Pressure Hydrocephalus
Normal Pressure Hydrocephalus
NPV - Negative Predictive Value
Negative Predictive Value
NSAID Pharmacology
Cyclo-oxygenase inhibition giving analgesia at the cost of gastric, renal and cardiovascular risk
NSCLC - Non-Small Cell Lung Cancer
Non-Small Cell Lung Cancer
NSIP - Non-Specific Interstitial Pneumonia
Non-Specific Interstitial Pneumonia
Nuclear Appearances
Chromatin pattern, nucleoli and shape indicate activity and malignancy
Nucleotide Synthesis Pathways
Purines are built onto the ribose; pyrimidines are built first then attached
Number Needed to Treat
NNT is the reciprocal of the absolute risk reduction
Nystagmus Types
Peripheral nystagmus is unidirectional and fatigable; central nystagmus is not
O-RADS - Ovarian-Adnexal Reporting and Data System
Ovarian-Adnexal Reporting and Data System
OA - Osteoarthritis
Osteoarthritis
Obesity and Energy Balance
Energy stores are defended by hormonal and metabolic adaptation to weight loss
Obstetric Abdominal Examination
Fundal height, lie, presentation, engagement and fetal heart
Obstructive Sleep Apnoea Assessment
STOP-BANG for screening, Epworth for sleepiness, polysomnography to confirm
Obstructive Sleep Apnoea Physiology
Repeated pharyngeal collapse causes intermittent hypoxia and arousals
Obstructive Versus Restrictive Physiology
Obstruction traps gas and raises volumes; restriction reduces all volumes
Obturator Hernia
Through the obturator canal, causing the Howship-Romberg sign
Obturator Nerve Functions
Adducts the thigh and supplies sensation to the medial thigh
Occupational and Travel History
Occupation, travel, animals, hobbies and contacts
Oedema Mechanisms in Pathology
Transudate from pressure change; exudate from increased permeability
Oesophageal Carcinoma Types
Squamous in the upper two-thirds, adenocarcinoma in the lower third
Oesophageal Constrictions
Cricopharyngeus, aortic arch, left main bronchus and the diaphragmatic hiatus
Oesophageal Hiatus Contents
Oesophagus, anterior and posterior vagal trunks, and the oesophageal branches of the left gastric vessels
Oesophageal Muscle Transition
Upper third striated, middle third mixed, lower third smooth
Oesophageal Relations in the Thorax
Trachea and heart in front, vertebral column and aorta behind, arch and azygos to the sides
Oesophageal Venous Drainage
Upper oesophagus drains systemically; the lower third drains to the left gastric vein and the portal system
Oesophagus Parts and Length
Cervical, thoracic and abdominal parts, totalling about 25 cm
Ohm's Law for the Circulation
Mean arterial pressure equals cardiac output multiplied by systemic vascular resistance
Omphalocele Versus Gastroschisis
Omphalocele is covered by a sac and central; gastroschisis is uncovered and to the right
Oncogenes and Tumour Suppressors
Oncogenes are the accelerator, tumour suppressors the brakes
Ondine's Curse and Central Hypoventilation
Automatic breathing is brainstem driven; voluntary breathing bypasses it through corticospinal tracts
One Carbon Metabolism
Folate carries one carbon units; B12 transfers the methyl group to homocysteine
OPG - Orthopantomogram
Orthopantomogram
Ophthalmic Nerve Branches
Frankly Lovely Nose
Ophthalmic Nerve Exit Point
One goes through the superior orbital fissure, the eye's own door
Opioid Conversion
Divide by two from oral to subcutaneous morphine, and remember the breakthrough dose
Opioid Overdose
The triad of reduced consciousness, respiratory depression and pinpoint pupils
Opioid Receptor Effects
Mu receptors give analgesia along with the main side effects
OPQRST
Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Time
Optic Canal Contents
Two travels with the artery too
Oral Hypoglycaemic Mechanisms
Reduce hepatic output, increase secretion, increase sensitivity, or increase excretion
Oral Rehydration Therapy
Glucose-coupled sodium absorption remains intact even in secretory diarrhoea
Orbicularis Oculi Ring Closure
Orbit the eye, orbicularis closes it, one ring muscle, one job, shut
Orbicularis Oris Purse String Action
Orbicularis oris puckers shut, like a drawstring purse pulled tight
Orbit Apex Structures
Optic canal medial, superior orbital fissure lateral, the apex splits the traffic
Orbit Wall Names
Room For Little Miracles
Orbitomeatal Baseline for Skull CT
Eye to ear hole, the baseline for a skull CT's role
Organic Acidaemias and Urea Cycle Defects
Organic acidaemias cause acidosis with a raised anion gap; urea cycle defects cause alkalosis
Oropharynx Boundaries
From the soft palate down to the hyoid's frame, tonsils and tongue base share this same domain
Osmolality and Osmolarity
Twice the sodium plus urea and glucose
Osmolality Regulation
Osmoreceptors control antidiuretic hormone and thirst
Osmolar Gap
Measured minus calculated osmolality, raised by unmeasured osmoles
Osmotic Diuresis
Unreabsorbed solute in the tubule holds water and drags electrolytes with it
Ossicle Order and Sound Path
Ma Married Ivan Stapel
Ossicles of the Middle Ear
Ma Married Ivan Stapel
Ossification and the Growth Plate
Intramembranous for flat bones, endochondral for long bones
Osteoporosis Versus Osteomalacia
Osteoporosis is too little normal bone; osteomalacia is poorly mineralised bone
Other Structures Piercing the Diaphragm
Left phrenic nerve, superior epigastric vessels, splanchnic nerves, hemiazygos vein and lymphatics
Otic Ganglion Location
Hangs under the oval door
Ovarian Reserve and Ageing
Oocyte number is fixed before birth and declines continuously thereafter
Oxidative Phosphorylation
Electrons pass down the chain, pumping protons that drive ATP synthase
Oxygen as a Drug
Target saturations of 94 to 98 per cent, or 88 to 92 per cent if at risk of hypercapnia
Oxygen Cascade
Oxygen tension falls stepwise from atmospheric to about 1 kPa in the mitochondrion
Oxygen Content Versus Saturation
Tension drives diffusion, saturation describes haemoglobin, content determines delivery
Oxygen Debt and EPOC
Excess post-exercise oxygen consumption repays stores and restores homeostasis
Oxygen Delivery Devices
From nasal cannulae to non-rebreathe and Venturi masks
Oxygen Delivery Equation
Delivery equals cardiac output multiplied by arterial oxygen content
Oxygen Dissociation Curve
A sigmoid curve with P50 of about 3.5 kPa or 27 mmHg
Oxygen Dissociation Curve Shifts
Acid, carbon dioxide, temperature and 2,3-DPG all shift it right
Oxygen Therapy Delivery Devices
Variable devices depend on the patient's breathing pattern; fixed devices do not
Oxygen Toxicity
Pulmonary damage from free radicals, plus central nervous system toxicity at high pressure
P Values and Confidence Intervals
A p value measures compatibility with the null hypothesis, not the size of an effect
P-value - Probability value
Probability value
PA - Posteroanterior
Posteroanterior
Pacemaker Action Potential
Phase 4 funny current, phase 0 calcium influx, phase 3 potassium efflux
PACS - Picture Archiving and Communication System
Picture Archiving and Communication System
PAD and DAB
Palmar ADduct, Dorsal ABduct
Paediatric Developmental Milestones
Gross motor, fine motor and vision, hearing and speech, social
Paediatric History Taking
Birth, development, feeding, immunisation and social history
Pain Gate Control Theory
Large fibre input inhibits transmission of small fibre pain signals
Pain Pathways
Transduction, transmission, modulation and perception
Palate Division by Tissue Type
Hard in front is bone, soft behind stands alone
Palate Fusion Sequence
Palatine shelves swing down then up then fuse, miss the timing, get the cleft
Palmar Arterial Arches
Superficial palmar arch mainly from the ulnar artery, deep palmar arch mainly from the radial artery
Pancreas Blood Supply
Head from the pancreaticoduodenal arcades; body and tail from the splenic artery
Pancreas Parts
Head, uncinate process, neck, body and tail
Pancreas Relations
Aorta, inferior vena cava, portal vein and left kidney behind; stomach in front
Pancreatic Development and Annular Pancreas
Ventral and dorsal buds fuse after the ventral bud rotates behind the duodenum
Pancreatic Ducts
Main duct of Wirsung to the major papilla; accessory duct of Santorini to the minor papilla
Pancreatic Islet Cell Types
Beta for insulin, alpha for glucagon, delta for somatostatin
Pancreatic Secretion
Bicarbonate from duct cells under secretin, enzymes from acinar cells under cholecystokinin
Paracetamol Overdose Biochemistry
NAPQI depletes glutathione, causing centrilobular necrosis
Paracolic Gutters
Grooves lateral to the ascending and descending colon; the right is deeper and continuous with the subhepatic space
Paranasal Sinus Drainage Pattern
Middle for most, superior for posterior ethmoid, sphenoid drains above all
Paranasal Sinus Group
Frontal Ethmoid Sphenoid Maxillary, all drain to the nose
Paranasal Sinus Pair Count
Four pairs drain the face, frontal ethmoid sphenoid maxillary find their place
Paraneoplastic Syndromes
Effects not explained by the tumour mass, its metastases or its hormones of origin
Parathyroid Gland Number and Position
Four glands, two up two down, tucked behind the thyroid's crown
Parietal Cell Acid Secretion
Acetylcholine, gastrin and histamine all converge on the proton pump
Parietal Pleura Parts
Costal, mediastinal, diaphragmatic and cervical pleura
Parkinson Disease Drugs
Levodopa with a decarboxylase inhibitor, dopamine agonists, MAO-B and COMT inhibitors
Parkinsonism Examination
Bradykinesia plus rigidity, tremor or postural instability
Parotid Duct Opening Site
Stensen's duct opens by the second upper molar
Parotid Gland Lobe Division
Facial nerve splits it superficial from deep, like a nerve drawn curtain
Pathological Calcification
Dystrophic occurs in damaged tissue; metastatic occurs in normal tissue with high calcium
PCA - Posterior Cerebral Artery
Posterior Cerebral Artery
PCL - Posterior Cruciate Ligament
Posterior Cruciate Ligament
PDAC - Pancreatic Ductal Adenocarcinoma
Pancreatic Ductal Adenocarcinoma
PE - Pulmonary Embolism
Pulmonary Embolism
Peak Expiratory Flow Interpretation
Effort dependent, compared with predicted or personal best
Pectinate Line
Above is visceral and insensitive; below is somatic and painful
Pectoralis Minor and Axillary Node Levels
Level I lateral to pectoralis minor, level II behind it, level III medial to it
Penicillin Allergy Assessment
Distinguish true IgE-mediated allergy from intolerance or a non-allergic rash
Pentose Phosphate Pathway
Produces NADPH and ribose-5-phosphate without making ATP
Peptic Ulcer Pathology
Helicobacter pylori and NSAIDs account for the great majority
PERCIST - PET Response Criteria in Solid Tumours
PET Response Criteria in Solid Tumours
Percussion Note Interpretation
Resonant, dull, stony dull and hyperresonant
Perfusion Versus Diffusion Limitation
Nitrous oxide is perfusion limited, carbon monoxide is diffusion limited, oxygen is normally perfusion limited
Pericardial Sinuses
Transverse sinus behind the great arteries; oblique sinus behind the left atrium
Pericardiocentesis Approach
Enter at Larrey's point, left of the xiphoid, aiming for the left shoulder at 30 degrees
Pericardium Layers
Fibrous pericardium, parietal serous layer, pericardial cavity, visceral serous layer
Periodic Breathing Patterns
Cheyne-Stokes waxes and wanes; Kussmaul is deep and rapid; Biot's is irregular
Peripheral Arterial Examination
Inspect, feel the pulses, then Buerger's test and the pressure index
Peripheral Nerve Structure
Endoneurium around axons, perineurium around fascicles, epineurium around the nerve
Peripheral Neurological Examination Sequence
Inspection, tone, power, reflexes, coordination, sensation, gait
Peripheral Signs of Infective Endocarditis
Janeway lesions, Osler nodes, Roth spots, splinter haemorrhages and clubbing
Peripheral Stigmata of Chronic Liver Disease
Signs of hyperoestrogenism, portal hypertension and failed synthesis
Peristalsis and the Law of the Gut
Contraction above the bolus and relaxation below it
Peritoneal Fluid Circulation
Fluid moves upwards towards the diaphragm and is absorbed through diaphragmatic lymphatics
Peritoneal Folds of the Duodenum
Superior, inferior and paraduodenal recesses, potential sites of internal hernia
Peritoneal Innervation
Parietal peritoneum is somatic and precisely localised; visceral peritoneum is autonomic and vague
Peritoneal Ligaments of the Stomach
Gastrohepatic, gastrosplenic, gastrocolic and gastrophrenic ligaments
Peritoneal Pouches
Rectovesical pouch in the male; vesicouterine and rectouterine pouches in the female
Peritonsillar Abscess Uvula Deviation
Uvula runs away from the pus bay
Permanent Tooth Eruption Order
Come Look, Canines First, Please, Please, Molars Meet
PET - Positron Emission Tomography
Positron Emission Tomography
PET-CT - Combined PET and CT
Combined PET and CT
Pharmacokinetics Principles
ADME: Absorption, Distribution, Metabolism, Excretion
Pharyngeal Arch Artery Derivatives
Third makes carotid, fourth makes arch and subclavian, sixth makes pulmonary and ductus
Pharyngeal Arch Cartilage Derivatives
Arch one Meckel's begun, arch two Reichert's true, arch three hyoid's key, arch four six larynx fix
Pharyngeal Arch Four and Six Nerve
Arch four six, Vagus fix
Pharyngeal Arch One Nerve
Arch one, chew like a Trigeminal son
Pharyngeal Arch Three Nerve
Arch three, swallow with Glosso key
Pharyngeal Arch Two Nerve
Arch two, smile like a Facial crew
Pharyngeal Constrictor Order
Sing Movies Play Backwards
Pharyngeal Pouch Fates
Ear, tonsil, thymus below, thymus above
Pharyngeal Wall Layer Order
My Friend Made Adjustments
Pharyngobasilar Fascia Function
The tough inner coat that holds the throat's shape afloat
Phases of Gastric Secretion
Cephalic, gastric and intestinal phases
Phases of Swallowing
Once Party Ends
Phenylketonuria
Phenylalanine hydroxylase deficiency, so phenylalanine accumulates and tyrosine becomes essential
Phosphate Handling by the Kidney
Reabsorbed proximally, and excretion is increased by parathyroid hormone and FGF23
Phrenic in Front
Phrenic nerve passes in Front of the lung root; the vagus passes behind
Phrenic Nerve Course in the Thorax
Right phrenic runs on the superior vena cava and pericardium; left phrenic crosses the aortic arch
PI-RADS - Prostate Imaging Reporting and Data System
Prostate Imaging Reporting and Data System
PICC - Peripherally Inserted Central Catheter
Peripherally Inserted Central Catheter
Piece Goods Often Go On Quilts
Piriformis, Gemellus superior, Obturator internus, Gemellus inferior, Obturator externus, Quadratus femoris
Piriform Fossa Clinical Relevance
A pocket beside the larynx, where sharp things like to hide and pinch
Pituitary Apoplexy
Sudden headache, visual loss and ophthalmoplegia with acute hypopituitarism
Pituitary Histology
Acidophils, basophils and chromophobes, each producing different hormones
Placenta Histology
Chorionic villi with syncytiotrophoblast, cytotrophoblast and fetal capillaries
Placental Function
Gas exchange, nutrition, excretion, endocrine and barrier functions
Platelet Function
Adhesion, activation, aggregation, then providing a surface for coagulation
Platelet Structure and Granules
Anucleate fragments with alpha and dense granules
Platysma Muscle Direction and Action
Runs from the chest to the jaw, tenses the neck like a drawn up shawl
Pleural Effusion Causes
Transudate is pressure, exudate is permeability
Pleural Effusion Physiology
Transudates from altered Starling forces; exudates from increased permeability
Pleural Fluid Analysis
Exudate or transudate first, then the specific tests
Pleural Innervation and Pain
Parietal pleura is somatically innervated and painful; visceral pleura is autonomic and insensitive
Pleural Pressure Gradient
Pleural pressure is more negative at the apex than at the base
Pleural Recesses
Costodiaphragmatic and costomediastinal recesses
Pneumoconioses
Coal, silica and asbestos, each with a characteristic pattern
Pneumonia Organisms by Context
The context predicts the organism
Pneumothorax Management
Primary or secondary, with symptoms and size deciding treatment
Pneumothorax Physiology
Loss of negative pleural pressure allows the lung to collapse and the chest wall to spring out
PNS
Peripheral nervous system
POCUS - Point-of-Care Ultrasound
Point-of-Care Ultrasound
Podocyte Structure
Interdigitating foot processes bridged by slit diaphragms
Poiseuille's Law
Flow is proportional to the fourth power of the radius
Polycystic Ovary Syndrome Physiology
Insulin resistance drives ovarian androgen production and disrupts ovulation
Polymerase Chain Reaction
Denature, anneal, extend, repeated in cycles
Popliteal Artery Branches
Divides into the anterior tibial artery and the tibioperoneal trunk
Popliteal Fossa Contents
From superficial to deep, tibial nerve, popliteal vein, popliteal artery
Portal Circulation Physiology
Low pressure system carrying 75 per cent of hepatic blood flow
Portal triad: DAVE
Duct, Artery, Vein, Epiploic foramen posteriorly
Portal Vein Formation
Union of the superior mesenteric and splenic veins behind the neck of the pancreas
Portosystemic Anastomoses
Oesophagus, umbilicus, rectum and retroperitoneum
Positive Pressure Ventilation Effects
It reverses the normal negative intrathoracic pressure, reducing venous return
Post-Obstructive Diuresis
Retained solute and impaired tubular function cause a large diuresis after decompression
Post-resuscitation Care
Treat the cause, control physiology, and delay prognostication
Posterior Abdominal Wall Muscles
Psoas major, iliacus, quadratus lumborum and transversus abdominis
Posterior Cord Branches - ULTRA
Upper subscapular, Lower subscapular, Thoracodorsal, Radial, Axillary
Posterior Cranial Fossa Contents
Cerebellum and stem, the deepest of them
Posterior Cricoarytenoid Action
PCA parts the cords apart
Posterior Interosseous Nerve Syndrome - Finger Drop
Finger drop with radial wrist deviation and no sensory loss
Posterior Leg - Deep Muscles
Popliteus, Flexor hallucis longus, Flexor digitorum longus and Tibialis posterior, supplied by the tibial nerve
Posterior Leg - Superficial Muscles
Gastrocnemius, soleus and plantaris, the triceps surae, supplied by the tibial nerve
Posterior Pituitary Hormones
Oxytocin and antidiuretic hormone, made in the hypothalamus and stored in the posterior lobe
Posterior Thigh - The Hamstrings
Biceps femoris, semitendinosus and semimembranosus, supplied by the sciatic nerve
Posterior Tibial Pulse
Just behind and below the medial malleolus
Posterior Triangle Boundaries
SCM in front, trapezius behind, clavicle's the floor you'll find
Posterior Triangle Contents
Accessory surfs, plexus peeks, artery anchors
Potassium Distribution and Shifts
Insulin, beta agonists and alkalosis drive potassium into cells
Potassium Handling by the Kidney
Filtered, largely reabsorbed proximally, then secreted in the distal nephron
Potency Versus Efficacy
Potency is the dose needed, efficacy is the maximum effect achievable
PPV - Positive Predictive Value
Positive Predictive Value
Preauricular Node Drainage
Preauricular nodes catch drainage from the eyelid and temple first
Predictive Values and Prevalence
Predictive values answer the clinician's question but depend on prevalence
Pregnancy Cardiovascular Changes
Cardiac output and volume rise, resistance and blood pressure fall
Pregnancy Hormones
hCG early from trophoblast, then progesterone and oestrogen from the placenta
Pregnancy Testing and hCG
Urine hCG for the question, serum hCG for the trend
Preload Determinants
Venous return, venous tone, blood volume, atrial contraction, heart rate and compliance
Prescribing in Liver Impairment
Reduced metabolism, reduced protein binding and increased sensitivity
Prescribing in Renal Impairment
Reduce the dose or lengthen the interval for renally cleared drugs
Prescribing in the Elderly
Altered pharmacokinetics and pharmacodynamics with high polypharmacy risk
Pressure Drop Across the Circulation
The greatest fall occurs across the arterioles
Pressure Natriuresis
A rise in arterial pressure increases sodium and water excretion
Pressure Ulcer Assessment
Four categories, plus unstageable and deep tissue injury
Pressure-Volume Loop
Filling, isovolumetric contraction, ejection, isovolumetric relaxation, traced anticlockwise
Primary Hyperaldosteronism
Hypertension with hypokalaemia, high aldosterone and suppressed renin
Primary Immunodeficiencies
B cell, T cell, combined, phagocyte or complement
Primitive Heart Tube Derivatives
Truncus arteriosus, bulbus cordis, primitive ventricle, primitive atrium and sinus venosus
Procalcitonin and Sepsis Biomarkers
Procalcitonin rises in bacterial infection and falls quickly with treatment
Profunda Femoris Branches
Medial and lateral circumflex femoral arteries and the perforating arteries
Pronation and Supination Muscles
Pronators are pronator teres and pronator quadratus; supinators are supinator and biceps brachii
Prone Positioning Physiology
It makes ventilation more uniform while perfusion remains relatively unchanged
Prostate Pathology
Hyperplasia affects the transition zone; carcinoma affects the peripheral zone
Protein Binding and Free Drug
Only the free fraction is active, and only the free fraction is cleared
Protein Digestion
Pepsin in the stomach, pancreatic proteases in the duodenum, brush border peptidases last
Protein Metabolism and the Urea Cycle
Ammonia from deamination is converted to urea in the liver
Protein Structure Levels
Primary sequence, secondary local folding, tertiary three-dimensional shape, quaternary subunits
Proximal Tubule Reabsorption
Two-thirds of sodium and water, and essentially all glucose, amino acids and bicarbonate
Proximal Tubule Secretion
Two non-specific pumps secrete a wide range of drugs and endogenous compounds
PSV - Peak Systolic Velocity
Peak Systolic Velocity
PTBD - Percutaneous Transhepatic Biliary Drainage
Percutaneous Transhepatic Biliary Drainage
PTC - Papillary Thyroid Carcinoma
Papillary Thyroid Carcinoma
Pterion Danger
Thin as paper, tear beneath, that's the pterion's deadly teeth
Pterion Location
Frontal Parietal Temporal Sphenoid meet at an H shaped handshake
Pterygopalatine Ganglion Location
The crying ganglion hangs from the maxillary nerve
Puberty Hormonal Trigger
Reactivation of pulsatile GnRH secretion after childhood quiescence
Puberty Sequence
Breast then pubic hair then growth spurt then menarche in girls; testicular enlargement first in boys
Pulmonary Capillary Wedge Pressure
An indirect measure of left atrial pressure, obtained by occluding a pulmonary artery branch
Pulmonary Circulation Characteristics
Low pressure, low resistance, high compliance, and it constricts in hypoxia
Pulmonary Embolism Assessment
Score first, then D-dimer or CT pulmonary angiogram
Pulmonary Embolism Physiology
Increased dead space, hypoxaemia from mismatch, and right ventricular strain
Pulmonary Hypertension Classification
Five groups, defined by the cause rather than the pressure
Pulmonary Ligament
A double fold of pleura hanging below the lung root
Pulmonary Oedema Physiology
Raised hydrostatic pressure or increased permeability floods the interstitium then alveoli
Pulmonary Trunk Bifurcation
Divides into right and left pulmonary arteries below the aortic arch at about T5
Pulmonary Veins
Four veins, two from each lung, draining to the left atrium
Pulse Character
Slow rising in aortic stenosis, collapsing in aortic regurgitation
Pulse Oximetry Principles
Two wavelengths distinguish oxyhaemoglobin from deoxyhaemoglobin in pulsatile blood
Pulse Pressure
Stroke volume divided by arterial compliance
Pump Handle and Bucket Handle
Upper ribs move like a pump handle, lower ribs like a bucket handle
Pupillary Light Reflex Pathway
In by two, out by three
Purine and Pyrimidine Bases
Pure As Gold: purines are Adenine and Guanine; the rest are pyrimidines
Purine Salvage and Gout
Xanthine oxidase produces uric acid; HGPRT salvages purines
PV - Portal Vein
Portal Vein
PWI - Perfusion-Weighted Imaging
Perfusion-Weighted Imaging
Pyramidal Lobe of the Thyroid
A leftover thumb pointing up from the thyroglossal duct's path
Pyrexia Assessment
Find the source, then the severity, then the risk factors
Pyruvate Dehydrogenase Complex
Irreversibly converts pyruvate to acetyl-CoA, requiring five cofactors
Q Angle of the Knee
The angle between the pull of the quadriceps and the patellar tendon, normally about 13 to 18 degrees
QT Interval and Torsades
Low potassium, magnesium and calcium, plus many drugs, prolong the QT interval
QT Prolonging Drugs
The As: antiarrhythmics, antibiotics, antipsychotics, antidepressants, antiemetics
Quadrangular Space Contents
Axillary nerve and posterior circumflex humeral artery
Quadriceps Femoris Components
Rectus femoris and the vastus lateralis, medialis and intermedius
RA - Renal Artery
Renal Artery
Raccoon Eyes Sign for Anterior Fossa Fracture
Black eyes with no punch thrown, anterior fossa fracture shown
RAD - Radiation Absorbed Dose
Radiation Absorbed Dose
Radial Nerve Lesion - Wrist Drop
Wrist drop from loss of the wrist and finger extensors
RADS - Reporting and Data System
Reporting and Data System
Raised Creatine Kinase Causes
Muscle injury from any cause, with rhabdomyolysis at the extreme
Raised Intracranial Pressure Management
Reduce brain water, blood volume or cerebrospinal fluid, or increase the space
RALS
Right Anterior, Left Superior
Randy Travis Drinks Cold Beer
Roots, Trunks, Divisions, Cords, Branches
Rapid Sequence Induction
The seven Ps, from preparation to post-intubation management
RCC - Renal Cell Carcinoma
Renal Cell Carcinoma
Re-entry Requirements
Two pathways, unidirectional block and slow conduction
Really Need Beer To Be At My Nicest
Radial Nerve, Biceps Tendon, Brachial Artery, Median Nerve
Receptor Regulation and Tolerance
Agonists downregulate receptors; antagonists upregulate them
RECIST - Response Evaluation Criteria in Solid Tumours
Response Evaluation Criteria in Solid Tumours
Rectal Blood Supply
Superior rectal from the inferior mesenteric, middle rectal from the internal iliac, inferior rectal from the internal pudendal
Rectum Features
No taeniae, no haustra, no appendices epiploicae and no mesentery
Rectus Sheath and the Arcuate Line
Above the arcuate line the sheath is complete; below it all aponeuroses pass in front
Rectus Sheath Haematoma
Above the arcuate line it is contained; below it, blood can spread freely
Recurrent Laryngeal Nerve and Thyroid Surgery Risk
The nerve runs behind the gland, cut carelessly, lose the voice command
Recurrent Laryngeal Nerve Course
Right hooks the pipe, left loops the arch, right's the short cut, left's the long march
Recurrent Laryngeal Nerve Motor Territory
Recurrent runs the rest, every intrinsic muscle except the one that's blessed by external
Red Cell Production
Driven by erythropoietin, requiring iron, B12 and folate
Reduced Consciousness Causes
AEIOU TIPS, covering the structural and metabolic causes
Refeeding Syndrome
Insulin drives phosphate, potassium and magnesium into cells
Reference Interval Interpretation in Biochemistry
Most abnormal results are explained before the sample reaches the analyser
Reference Ranges and the Abnormal Result
Reference ranges are defined statistically, not clinically
Reflex Nerve Roots
Counting 1, 2, 3, 4, 5, 6, 7, 8 from the ankle upwards
Regional Gut Mucosa
Each region has a characteristic epithelium and glandular pattern
Reid's Baseline for Skull Imaging
A line from the eye to the ear, the skull's horizontal frontier
Renal Autoregulation
Myogenic response and tubuloglomerular feedback
Renal Blood Flow Distribution
The cortex receives most of the flow; the medulla is relatively hypoxic
Renal Clearance
The volume of plasma completely cleared of a substance per unit time
Renal Compensation for Acid-Base Disorders
Slow but powerful, taking days but capable of large adjustments
Renal Corpuscle Structure
Glomerular capillaries, Bowman capsule, podocytes and mesangium
Renal Denervation and Transplant Physiology
Autoregulation and hormonal control persist, but neural reflexes are lost
Renal Drug Handling
Filtration of free drug, active secretion, and passive reabsorption depending on pH
Renal Fascia Layers
Renal capsule, perirenal fat, renal (Gerota's) fascia, pararenal fat
Renal Handling of Acid
Bicarbonate reclamation proximally, then titratable acid and ammonium distally
Renal Handling of Urea
Reabsorbed passively, with the amount depending on tubular flow rate
Renal Handling of Water Load
Suppressed antidiuretic hormone allows maximally dilute urine
Renal Hilum Arrangement
Vein, Artery, Ureter from front to back
Renal Papilla and Collecting System
Papilla, minor calyx, major calyx, renal pelvis, ureter
Renal Physiology in Pregnancy
GFR rises by about 50 per cent, so creatinine and urea fall
Renal Physiology in the Neonate
Low GFR and limited concentrating ability, maturing over the first two years
Renal Response to Exercise
Renal blood flow falls as blood is diverted to muscle, with sodium and water conservation
Renal Response to Hypovolaemia
Reduced filtration, increased proximal reabsorption, and hormonal salt and water retention
Renal Stone Formation
Supersaturation, low urine volume, and lack of inhibitors
Renal Tubular Acidosis Types
Type 1 distal, type 2 proximal, type 4 hypoaldosteronism
Renal Tumours
Renal cell carcinoma in adults, Wilms tumour in children, urothelial carcinoma in the collecting system
Renin-Angiotensin-Aldosterone System
Renin, angiotensinogen, angiotensin I, ACE, angiotensin II, aldosterone
Respiratory Acidosis Causes
Anything reducing alveolar ventilation, from brain to alveolus
Respiratory Alkalosis Causes
Hypoxia, central stimulation, lung disease, drugs and anxiety
Respiratory Centres
Medullary dorsal and ventral groups, with pontine pneumotaxic and apneustic centres
Respiratory Changes in Pregnancy
Tidal volume and minute ventilation rise, functional residual capacity falls
Respiratory Epithelium Transition
Pseudostratified ciliated columnar becomes simple squamous as the airway narrows
Respiratory Examination Sequence
Hands, face, neck, then chest front and back with the same four steps
Respiratory Failure Types
Type 1 is hypoxaemia alone; type 2 adds hypercapnia
Respiratory Quotient
Carbohydrate 1.0, protein 0.8, fat 0.7, mixed diet about 0.8
Response to Haemorrhage
Baroreflex tachycardia and vasoconstriction, then fluid shift and hormonal retention
Response to Standing
Blood pools in the legs, venous return falls, and the baroreflex compensates
Resting Membrane Potential
Potassium permeability dominates, giving about minus 70 millivolts
Retinal Layers
Light passes through the retina to reach the photoreceptors at the back
Retromammary Space
A layer of loose areolar tissue between the breast and pectoral fascia
Retroperitoneal Spaces
Anterior pararenal, perirenal and posterior pararenal spaces
Retropharyngeal Space Danger
Danger space, no floor at all, straight down to the chest you fall
Reversible Versus Irreversible Cell Injury
Membrane damage and mitochondrial failure mark irreversibility
RFA - Radiofrequency Ablation
Radiofrequency Ablation
Rhabdomyolysis Physiology
Myoglobin, potassium, phosphate and creatine kinase are released into the circulation
Rheumatic Fever Criteria
JONES for the major criteria, FEAR for the minor
RI - Resistive Index
Resistive Index
Rib Fracture Patterns
Upper ribs suggest severe force, lower ribs threaten abdominal organs, multiple ribs risk flail chest
Richter's Hernia
Only the antimesenteric border of the bowel enters the sac
Right Atrium Features
Crista terminalis, pectinate muscles, fossa ovalis and the openings of the venae cavae and coronary sinus
Right Hemidiaphragm Sits Higher
The liver pushes the right dome up; the heart presses the left dome down
Right Lymphatic Duct Territory
The right head and neck, right arm and right thorax, the right upper quadrant of the body
Rigler's Sign and Pneumoperitoneum
Gas on both sides of the bowel wall makes it visible as a thin line
Rima Glottidis Width Changes
Wide to breathe, narrow to whisper, a silent gap grows slimmer
Rinne and Weber Test Logic
Rinne negative, bone beats air, conductive loss is there, Weber runs to the bad ear when it's conductive
RIP
Rectus abdominis, Inferior epigastric vessels, Poupart's ligament
RIS - Radiology Information System
Radiology Information System
Risorius Smiling Action
The smiler's muscle, risorius rhymes with glorious grin
RLL - Right Lower Lobe
Right Lower Lobe
RML - Right Middle Lobe
Right Middle Lobe
RNA Types and Functions
Messenger carries, transfer delivers, ribosomal builds
ROC - Receiver Operating Characteristic
Receiver Operating Characteristic
Root of the Mesentery
Runs obliquely from the duodenojejunal flexure to the right sacroiliac joint, about 15 cm long
Rotator Cuff Actions
Supraspinatus abducts, Infraspinatus and Teres minor laterally rotate, Subscapularis medially rotates
Rotator Cuff Insertions - SIT on the Greater Tubercle
Supraspinatus, Infraspinatus and Teres minor on the greater tubercle; Subscapularis on the lesser tubercle
Rotator Cuff Nerve Supply
Suprascapular nerve, Upper and lower Subscapular nerves, Axillary nerve
Routes of Administration
Enteral routes are convenient; parenteral routes bypass first pass metabolism
Routes of Tumour Spread
Local invasion, lymphatic, haematogenous, transcoelomic and perineural
Rovsing's Sign
Pressure in the left iliac fossa produces pain in the right iliac fossa
RR
Respiratory rate
RTC - Rotator Cuff
Rotator Cuff
RUL - Right Upper Lobe
Right Upper Lobe
Rule of 2s, 4s and 6s
Lung borders cross ribs 6, 8 and 10; pleural borders cross ribs 8, 10 and 12
Rule of Three in the Spermatic Cord
Three arteries, three nerves, three other structures
RV - Renal Vein
Renal Vein
S1 - Sacral vertebra 1
Sacral vertebra 1
SAD PUCKER
Suprarenal, Aorta and IVC, Duodenum, Pancreas, Ureters, Colon, Kidneys, Esophagus, Rectum
Sagittal Suture Surface Landmark
Runs straight down the middle like a part in your hair
SAH - Subarachnoid Haemorrhage
Subarachnoid Haemorrhage
Salicylate Overdose
A mixed respiratory alkalosis and metabolic acidosis, with tinnitus
Salicylate Poisoning
Respiratory alkalosis from central stimulation plus a high anion gap metabolic acidosis
Saliva Composition and Function
Hypotonic fluid with amylase, mucins, lysozyme and bicarbonate
Salivary Gland Histology
Parotid serous, sublingual mucous, submandibular mixed
Saphenous Nerve
The largest cutaneous branch of the femoral nerve, supplying the medial leg and foot
Sarcoidosis Features
Non-caseating granulomas affecting any organ, most often the lung
Sarcomere Bands and Lines
A band stays the same, I band and H zone shorten
Sarcopenia and Frailty
Progressive loss of muscle mass, strength and function with age
Say Grace before Tea
Sartorius, Gracilis and semiTendinosus
SBAR Handover
Situation, Background, Assessment, Recommendation
SBP
Systolic blood pressure
Scalp Layers Front to Back
SCALP
Scaphoid Blood Supply - Retrograde Flow
The scaphoid is supplied retrogradely from distal to proximal by the radial artery
Sciatic Nerve Divisions
The sciatic nerve splits into the tibial nerve and the common fibular (peroneal) nerve
SCLC - Small Cell Lung Cancer
Small Cell Lung Cancer
Screening Programme Criteria
The condition, the test, the treatment and the programme
Screw The Lawyer, Save A Patient
Superior Thoracic, Thoracoacromial, Lateral Thoracic, Subscapular, Anterior Circumflex Humeral, Posterior Circumflex Humeral
Scrotal Examination
Can you get above it, is it separate from the testis, does it transilluminate
SDH - Subdural Haematoma
Subdural Haematoma
Second Branchial Cleft Cyst Location
Along the SCM's front edge, second cleft hugs the muscle's ledge
Secondary Hypertension Causes
Renal, endocrine, vascular and drug causes
Secondary Prevention After Myocardial Infarction
The four drugs, plus rehabilitation and risk factor control
Seizure Physiology
Excessive synchronous neuronal discharge from an imbalance of excitation and inhibition
Selenium, Copper and Zinc
Each is a cofactor whose loss produces a recognisable syndrome
Semen Analysis Parameters
Volume, concentration, motility and morphology
Semicircular Canal Plane Arrangement
Three canals, three planes, anterior posterior lateral, each at right angles
Sensitivity and Specificity
SnNout and SpPin
Sensory Pathways
Dorsal columns carry fine touch and proprioception; spinothalamic carries pain and temperature
Sepsis Recognition
Life-threatening organ dysfunction from a dysregulated response to infection
Sepsis Six
Three in and three out, within one hour
Serotonin Syndrome
Autonomic, neuromuscular and mental state changes, with clonus
Serratus Anterior - The Boxer's Muscle
Serratus anterior protracts the scapula and is supplied by the long thoracic nerve
Serratus Anterior and the Long Thoracic Nerve
Arises from the outer surface of the upper eight or nine ribs, supplied by the long thoracic nerve
Serratus Posterior and Levatores Costarum
Serratus posterior superior elevates the upper ribs, serratus posterior inferior depresses the lower ribs
Sexual Differentiation
SRY drives testis formation; without it the default pathway is female
Shock Classification
Hypovolaemic, cardiogenic, obstructive and distributive
Shock Recognition at the Bedside
Inadequate tissue perfusion, recognised before hypotension appears
Shock Stages
Compensated, decompensated and irreversible
Short Bowel Syndrome Physiology
Reduced absorptive surface, rapid transit and loss of specialised ileal function
Short Synacthen Test
Measure cortisol before and after synthetic ACTH
Shoulder Abduction Muscle Sequence
Supraspinatus 0 to 15 degrees, Deltoid 15 to 90 degrees, Trapezius and Serratus anterior 90 to 180 degrees
Shoulder and Knee Special Tests
Impingement and cuff tests at the shoulder; ligament and meniscal tests at the knee
Shoulder Examination
Look, feel, move actively then passively, then the rotator cuff tests
Shoulder Joint Movements
Flexion, extension, abduction, adduction, medial rotation, lateral rotation and circumduction
SIADH Diagnostic Criteria
Hyponatraemia with concentrated urine in a euvolaemic patient with normal endocrine and renal function
Sick Day Rules in Diabetes
Never stop insulin, monitor more often, and maintain fluid and carbohydrate intake
Sickle Cell Physiology
A single amino acid substitution causes polymerisation of deoxygenated haemoglobin
SIGECAPS
Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor changes, Suicidal ideation
Sigmoid Volvulus
A long, mobile loop on a narrow mesenteric base
Signs of Respiratory Distress
Rate, accessory muscles, recession, position and the ability to speak
Silhouette Sign
Loss of a normal border means the abnormality is in contact with that structure
Sinus Arrhythmia
Heart rate rises on inspiration and falls on expiration through varying vagal tone
Sister Mary Joseph Nodule
A metastatic nodule at the umbilicus, spreading along the ligamentum teres or peritoneal fluid
SITS
Supraspinatus, Infraspinatus, Teres minor, Subscapularis
Six Extensor Compartments of the Wrist
The six synovial tunnels deep to the extensor retinaculum and their tendons
Skeletal Muscle Blood Flow
Sympathetic tone at rest, metabolic vasodilatation during exercise
Skeletal Muscle Fibre Types
Type I slow oxidative, type IIa fast oxidative, type IIx fast glycolytic
Skeletal Muscle Microstructure
A band is dark and constant, I band is light and shortens
Skin Appendages
Hair follicles, sebaceous glands, eccrine and apocrine sweat glands, nails
Skull Suture Order
Cats Purr Slowly
Sleep and Breathing
Ventilation falls, carbon dioxide rises slightly and upper airway tone is reduced
Sleep Stages
Three non-REM stages and REM sleep, cycling about every 90 minutes
Sliding Filament Mechanism
Filaments slide past each other without changing length, powered by ATP
SMA - Superior Mesenteric Artery
Superior Mesenteric Artery
Small Bowel Absorption Sites
Iron in the duodenum, folate in the jejunum, B12 and bile salts in the terminal ileum
Small Complex and Voltage Criteria
Left ventricular hypertrophy criteria, and the causes of small complexes
Small Intestinal Surface Area
Plicae, villi and microvilli multiply the area 600-fold
Small Saphenous Vein Course
Runs behind the lateral malleolus up the back of the calf to the popliteal vein
Smoking and Respiratory Physiology
Impaired clearance, carboxyhaemoglobin, protease imbalance and accelerated decline in FEV1
Smooth Muscle Contraction
Calcium acts through calmodulin and myosin light chain kinase, not troponin
SNR - Signal to Noise Ratio
Signal to Noise Ratio
SOAP
Subjective, Objective, Assessment, Plan
SOCRATES Pain History
Site, Onset, Character, Radiation, Associations, Time course, Exacerbating factors, Severity
Sodium Reabsorption Along the Nephron
Proximal 65 per cent, loop 25 per cent, distal 5 per cent, collecting duct 3 per cent
Soft Palate Muscles
Tall Ladies Prefer Pretty Umbrellas
SOL - Space-Occupying Lesion
Space-Occupying Lesion
Some Irish Sailor Pesters Polly
Superior gluteal, Inferior gluteal, Sciatic, Posterior femoral cutaneous, Pudendal
Some Lovers Try Positions That They Can't Handle
Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate
Some Say Marry Money
Sensory, Sensory, Motor, Motor, Both, Motor, Both, Sensory, Both, Both, Motor, Motor
Sorbitol Pathway
Aldose reductase converts glucose to sorbitol, which is trapped inside cells
Sound Conduction Pathway Summary
Pinna funnels, drum vibrates, ossicles amplify, cochlea converts
SPECT - Single Photon Emission Computed Tomography
Single Photon Emission Computed Tomography
Spermatic Cord Coverings
External spermatic from external oblique, cremasteric from internal oblique, internal spermatic from transversalis fascia
Spermatogenesis
Spermatogonia to spermatozoa over about 70 days
Sphenoid Sinus Neighbour Danger
Sits beneath the pituitary gland, a neighbour you don't want too grand
Sphincter of Oddi and Bile Flow
Cholecystokinin contracts the gallbladder and relaxes the sphincter
Spigelian Hernia
Through the linea semilunaris, usually just below the arcuate line
Spinal Cord Tracts
Dorsal columns behind, corticospinal laterally, spinothalamic anterolaterally
Spine Examination
Inspection, movement, palpation and the neurological screen
Spirometry Patterns
Obstructive lowers the ratio; restrictive lowers both values proportionately
Splanchnic Blood Flow and Digestion
Splanchnic flow rises by up to 100 per cent for several hours after eating
Splanchnic Circulation
A quarter of cardiac output at rest, arranged largely in series through the portal vein
Splanchnic Nerve Levels
Greater T5 to T9, lesser T10 to T11, least T12
Spleen Functions
Filtration, immunity, storage and, in the fetus, haematopoiesis
Spleen Histology
White pulp is lymphoid; red pulp filters blood
Spleen: Odd Numbers Rule
1 by 3 by 5 inches, 7 ounces, between ribs 9 and 11
Splenic Enlargement Direction
Enlarges downwards and medially, towards the right iliac fossa
Splenic Ligaments
Gastrosplenic ligament carries the short gastric vessels; splenorenal ligament carries the splenic vessels and pancreatic tail
Splenius Muscle Actions
Splenius extends and rotates the head like a splint holding it straight
Splitting of the Second Heart Sound
Normal splitting widens on inspiration; wide, fixed and reversed splitting are abnormal
SpO2
Peripheral oxygen saturation
SSD - Shaded Surface Display
Shaded Surface Display
SSRI Prescribing and Safety
Effective but slow, with early worsening and a discontinuation syndrome
ST Elevation Versus Depression
Elevation suggests transmural injury; depression suggests subendocardial ischaemia
Starling Forces
Hydrostatic pressure pushes fluid out, oncotic pressure pulls it back
Starling Forces in the Glomerulus
Glomerular capillary pressure drives filtration; oncotic and capsular pressures oppose it
Static Versus Dynamic Exercise
Dynamic exercise is a volume load; static exercise is a pressure load
Statins and Lipid Lowering
Statins inhibit HMG-CoA reductase; ezetimibe blocks absorption; PCSK9 inhibitors preserve LDL receptors
Status Epilepticus Management
Benzodiazepine twice, then phenytoin or levetiracetam, then anaesthesia
Stem Cell Niches
Crypt base in gut, basal layer in epidermis, limbus in cornea
Sternal Angle Landmarks
The angle of Louis marks T4/T5, the second costal cartilage, the carina and the limits of the aortic arch
Sternoclavicular Joint
A saddle-shaped synovial joint with an articular disc, the sole articulation of the limb with the trunk
Sternocleidomastoid Actions
Same Side Tilt, Opposite Side Turn
Sternum Parts and Sternal Puncture
Manubrium, body and xiphoid process, with marrow aspirated from the body at the level of the second space
Steroid Hormone Mechanism
Steroids act on intracellular receptors and alter gene transcription
Stewart Physicochemical Approach
pH is determined by the strong ion difference, weak acids and carbon dioxide
Stomach Bed
Pancreas, spleen, left kidney and adrenal, diaphragm, transverse mesocolon and splenic artery
Stomach Blood Supply
Left and right gastric on the lesser curve, left and right gastro-omental on the greater curve, plus short gastrics
Stomach Muscle Layers
Inner oblique, middle circular and outer longitudinal
Stomach Parts
Cardia, fundus, body, antrum and pylorus
Stool Testing
Culture, toxin, antigen, calprotectin and elastase answer different questions
Stress Response
Catabolic hormones rise, insulin falls, and salt and water are retained
Stroke Pathology
Ischaemic in about 85 per cent, haemorrhagic in 15 per cent
Stroke Volume Determinants
Preload, Afterload, Contractility
Structured History Framework
Presenting complaint, history, past history, drugs, allergies, family, social, systems review
Structures Passing Through the Parotid Gland
Some Anatomists Vow Never Forget
Structures Superficial to the Flexor Retinaculum
Ulnar nerve and artery, palmaris longus tendon and the palmar cutaneous branches of the median and ulnar nerves
Stylomastoid Foramen
Between the style and the mastoid, the face makes its exit
Subclavian Artery Branch Order
VIT-C, D
Sublingual Gland Duct Pattern
Many little ducts, no single big door
Submandibular Duct Opening Site
Wharton's duct opens at the front floor, beside the tongue's tied door
Submandibular Ganglion Location
Hangs from the lingual nerve like a drop of drool
Suicide Risk Assessment
Before, during and after the act, plus static and dynamic risk factors
Superficial Extensors of the Posterior Forearm
Brachioradialis, Extensor carpi radialis longus and brevis, Extensor digitorum, Extensor digiti minimi, Extensor carpi ulnaris, Anconeus
Superficial Inguinal Node Drainage
Lower limb, buttock, abdominal wall below the umbilicus, perineum, anal canal below the pectinate line and scrotal skin
Superficial Temporal Artery Landmark
Feel it just in front of the ear, the temple's pulse is always near
Superficial Veins of the Upper Limb
Cephalic vein laterally, basilic vein medially, median cubital vein joining them at the elbow
Superior and Inferior Oblique Actions
SIN and RAD
Superior Gluteal Nerve - Trendelenburg Sign
Supplies the hip abductors; injury causes the pelvis to drop on the opposite side
Superior Intercostal Artery and Vein
Superior intercostal artery from the costocervical trunk; superior intercostal vein to the brachiocephalic or azygos vein
Superior Laryngeal Nerve Two Branches
Internal feels, external tightens, two branches with two different heightenings
Superior Mesenteric Artery Branches
Inferior pancreaticoduodenal, jejunal and ileal, ileocolic, right colic and middle colic arteries
Superior Mesenteric Artery Syndrome
The third part of the duodenum is compressed between the aorta behind and the superior mesenteric artery in front
Superior Orbital Fissure Contents
Live Free To See Anything
Superior Vena Cava Formation
Union of the right and left brachiocephalic veins, with the azygos vein as its only named tributary
Supraclavicular Node and Troisier's Sign
Troisier finds trouble on the left, above the collarbone's cleft
Suprahyoid Muscles
Some Guys Marry, Divorce, Get Married
Supraventricular Tachycardia Management
Vagal manoeuvres, then adenosine, then rate control
Sural Nerve - The Biopsy Nerve
Formed by branches of the tibial and common fibular nerves, supplying the posterolateral leg and lateral foot
Surfactant Deficiency in the Neonate
Surfactant deficiency causes high surface tension, alveolar collapse and stiff lungs
Surfactant Functions
Reduces surface tension, increases compliance, stabilises alveoli and keeps them dry
Suture Closure Timing Order
Post is quick, ant takes its time
SUV - Standardised Uptake Value
Standardised Uptake Value
SUVmax - Maximum Standardised Uptake Value
Maximum Standardised Uptake Value
Swallowing Phases
Oral voluntary, pharyngeal reflex, oesophageal peristalsis
Sympathetic Trunk in the Thorax
Runs on the heads of the ribs, with about eleven or twelve ganglia and the stellate ganglion at its upper end
Synaptic Transmission Steps
Depolarisation, calcium entry, vesicle fusion, receptor binding, then termination
Syncope Assessment
Reflex, orthostatic or cardiac, with cardiac the one that kills
Syncope Mechanisms
Reflex, orthostatic and cardiac causes, all reducing cerebral perfusion
Synovial Fluid Analysis
Appearance, cell count, crystals and Gram stain
Systems Review
A brief screen of each body system to catch what the history has missed
Systole and Diastole Duration
About one-third systole and two-thirds diastole at rest
T Cell Subsets
CD4 helper cells coordinate; CD8 cytotoxic cells kill
Targeted Cancer Therapies
Monoclonal antibodies, tyrosine kinase inhibitors and checkpoint inhibitors
Tarsal Bones
Talus, Calcaneus, Navicular, Cuboid and the medial, intermediate and lateral Cuneiforms
TAS - Transabdominal Scan
Transabdominal Scan
Taste and Smell
Five basic tastes carried by three cranial nerves, and smell by the olfactory nerve
Taste Buds and Tongue Papillae
Filiform have none; fungiform, circumvallate and foliate do
Taste Map Myth Buster
Sweet salty sour bitter, all buds sense them all, no zone is stricter
Taste Versus General Sensation of the Tongue
Front Chorda, Back Glosso
TEE - Transoesophageal Echocardiogram
Transoesophageal Echocardiogram
Temperature Regulation
The hypothalamus compares core temperature with a set point and drives heat loss or gain
Tendon and Ligament Physiology
Dense type I collagen with poor blood supply and slow healing
Tension Pneumothorax Mechanism
A one-way valve traps air, raising intrathoracic pressure and obstructing venous return
Testicular Descent
From the posterior abdominal wall through the inguinal canal into the scrotum by birth
Testicular Lymphatic Drainage
Testis drains to para-aortic nodes; scrotum drains to inguinal nodes
Testicular Tumours
Germ cell tumours predominate, divided into seminoma and non-seminoma
Testis and Ovary Histology
Seminiferous tubules with Sertoli cells; ovarian follicles at successive stages
Tetralogy of Fallot
PROVe: Pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, VSD
The 4 Ts of an Anterior Mediastinal Mass
Thymoma, Teratoma, Thyroid (retrosternal), Terrible lymphoma
The Sick Child Assessment
The paediatric assessment triangle: appearance, breathing, circulation
Thenar Muscles - OAF
Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis
Therapeutic Drug Monitoring
Narrow therapeutic index drugs where effect cannot be measured directly
Therapeutic Index
The ratio of the toxic dose to the effective dose
Thermodynamics of Metabolism
Unfavourable reactions are driven by coupling them to ATP hydrolysis
Thermoregulation During Exercise
Evaporation is the main route of heat loss, and it fails in high humidity
Thiamine Deficiency Syndromes
Wet beriberi, dry beriberi and Wernicke-Korsakoff syndrome
Third Nerve Palsy Triad
Down and out, lid's dropping, pupil's blown
Thoracic Aorta Branches
Bronchial, oesophageal, mediastinal and pericardial branches, plus posterior intercostal and subcostal arteries
Thoracic Dermatome Landmarks
T4 at the nipple, T6 at the xiphoid, T10 at the umbilicus, L1 at the groin
Thoracic Duct Course
Begins at the cisterna chyli, crosses to the left at T5, drains into the left venous angle
Thoracic Inlet Contents
Trachea and oesophagus centrally, with vessels and nerves on either side
Thoracic Lymph Node Groups
Parietal nodes drain the wall; visceral nodes drain the organs
Thoracic Vertebral Features
Costal facets on the body and transverse process, with long downward-sloping spinous processes
Thoracic Vertebral Level Landmarks
T1 inlet, T4/5 sternal angle, T8 caval, T9 xiphisternum, T10 oesophagus, T12 aorta
Three Salivary Glands
Peter Piper's Salty Snacks
Thrombocytopenia Causes
Reduced production, increased destruction, sequestration or dilution
Thrombophilia Screening
Factor V Leiden is commonest inherited; antiphospholipid syndrome commonest acquired
Thrombus Versus Post-mortem Clot
Lines of Zahn and attachment to the wall mark a true thrombus
Thymic Sail Sign
A triangular projection from the upper mediastinum in an infant, resembling a sail
Thymus Histology
Cortex of dense thymocytes, medulla with Hassall corpuscles
Thymus Position and Origin
A third pharyngeal pouch derivative lying in the anterior and superior mediastinum
Thyrocervical Trunk Branches
Try Swallowing Slowly
Thyroglossal Duct Path
From the tongue's back door down to its final address, cysts can pop up anywhere on the way
Thyroid and Endocrine Test Pitfalls
Timing, binding proteins, assay interference and acute illness all distort results
Thyroid and Parathyroid Histology
Thyroid follicles filled with colloid; parathyroid chief and oxyphil cells
Thyroid Cartilage Shield Shape
Shield shaped, guards the throat like ancient armour plate
Thyroid Cartilage Vertebral Level
Thyroid cartilage marks C4 to C5, the Adam's apple's home address
Thyroid Drug Pharmacology
Levothyroxine for replacement, thionamides for suppression
Thyroid Examination
Inspect, swallow, protrude tongue, palpate from behind, then assess function
Thyroid Function Test Patterns
TSH is the most sensitive marker, moving before free T4 changes
Thyroid Gland Blood Supply Direction
Superior comes from above, inferior climbs from below
Thyroid Hormone Actions
Increases basal metabolic rate and potentiates catecholamine effects
Thyroid Hormone Synthesis
Iodide trapping, oxidation, organification, coupling, storage and release
Thyroid Hormone Transport and Free Fraction
Over 99 per cent is protein bound, so only the free fraction is active
Thyroid Isthmus Vertebral Level
Two three the isthmus you see, right below the cricoid at C6
Thyroid Status Assessment
Examine the gland, then the status, then the complications
Thyroid Storm
Block synthesis, block release, block conversion, block effects, and support
TI-RADS - Thyroid Imaging Reporting and Data System
Thyroid Imaging Reporting and Data System
Tibial Nerve Functions
Plantarflexes and inverts the foot and supplies sensation to the sole
Time Constants in the Lung
Time constant equals resistance multiplied by compliance
Tissue Processing Steps
Fixation, dehydration, clearing, embedding, sectioning and staining
TMJ
Temporomandibular joint
TMJ Disc Position
Disc rides on top of the condyle like a saddle, dividing the joint in two
TMJ Ligament Group
TSS holds the jaw on a leash
TMJ Opening Movement Sequence
Rotation opens a little, translation opens a lot, hinge then glide, that's the plot
TOE - Transoesophageal Echocardiogram
Transoesophageal Echocardiogram
Tolerance and Dependence
Receptor downregulation, enzyme induction and physiological adaptation
Tom, Dick and Very Nervous Harry
Tibialis posterior, flexor Digitorum longus, posterior tibial Artery and Veins, tibial Nerve, flexor Hallucis longus
Tongue Development Origins by Region
Anterior two thirds from arch one, posterior third from arch three, different origins, same organ, that's why the nerves differ too
Tongue Extrinsic Muscles
Style Helps Genius Pals
Tongue Lymphatic Drainage Pattern
Tip and back drain both sides, the sides only drain their own side
Total Skull Bone Count
Twenty two bones build the skull's house, eight cranial, fourteen facial, quiet as a mouse
Towne's View for Skull Imaging
Towne's looks through the foramen magnum, straight down the pipe
Toxidromes
Anticholinergic, cholinergic, sympathomimetic, opioid and sedative patterns
Trace Elements
Zinc, copper, iodine, selenium and chromium, each with a characteristic syndrome
Tracheal Deviation Causes
Pushed away by pneumothorax and effusion; pulled towards by collapse and fibrosis
Tracheal Relations in the Thorax
Aortic arch and great vessels in front and to the left, oesophagus behind
Tracheal Structure
Sixteen to twenty C-shaped cartilages, open posteriorly and bridged by the trachealis muscle
Tracheo-oesophageal Fistula Types
Proximal oesophageal atresia with a distal fistula in about 85 per cent
Tracheostomy Site Landmark
Between rings two and three, below the cricoid, that's the key
Training Adaptations
Endurance training improves oxygen delivery and use; resistance training increases muscle size and neural drive
Transcription and Translation
Transcription in the nucleus, processing, then translation on ribosomes
Transfer Factor Interpretation
TLCO measures diffusion; KCO corrects it for the volume available
Transfusion Reactions
Acute haemolytic, febrile, allergic, TACO and TRALI
Transplant Rejection Types
Hyperacute in minutes, acute in weeks, chronic over years
Transpulmonary Pressure
Alveolar pressure minus pleural pressure
Transpyloric Plane of Addison
At L1, halfway between the suprasternal notch and the pubic symphysis
Transversalis Fascia and the Deep Ring
A continuous fascial sheet whose defect forms the deep inguinal ring
Transversus Thoracis and the Innermost Layer
Transversus thoracis in front, innermost intercostals laterally, subcostals behind
Trapezius Three Part Action
Upper shrugs, middle retracts, lower depresses
Trauma Primary Survey
Catastrophic haemorrhage first, then Airway, Breathing, Circulation, Disability, Exposure
Treacher Collins Syndrome and Arch One
Arch one's a mess, jaw and ear both regress
Triangle of Safety
Lateral border of pectoralis major, anterior border of latissimus dorsi, and a line above the fifth intercostal space
Triangular Interval, Triangular Space and Quadrangular Space
Triangular space holds the circumflex scapular artery; quadrangular space holds the axillary nerve; triangular interval holds the radial nerve
Tricuspid Valve Papillary Muscles
Anterior, posterior and septal papillary muscles, with the moderator band to the anterior muscle
Tricyclic Antidepressant Overdose
Anticholinergic, cardiac and neurological toxicity together
Trigeminal Nerve Three Divisions
Standing Room Only
Triptans and Migraine Therapy
Triptans are 5-HT1 agonists causing cranial vasoconstriction
Troponin Interpretation
A marker of myocardial injury, not of myocardial infarction
Trousseau's Sign for Hypocalcaemia
Cuff the arm, the hand spasms like a claw, another calcium low flaw
Try Pulling My Aorta
Tricuspid, Pulmonary, Mitral, Aortic
Tuberculosis Clinical Features
Chronic cough, weight loss, night sweats and upper lobe cavitation
Tuberculosis Testing
Smear, culture and NAAT for active disease; Mantoux and IGRA for latent
Tubular Epithelium by Segment
Proximal tubule has a brush border; distal tubule does not
Tumour Markers
Most are for monitoring rather than diagnosis or screening
Tumour Staging and Grading
Stage is how far it has spread; grade is how abnormal it looks
TUS - Testicular Ultrasound
Testicular Ultrasound
TVS - Transvaginal Ultrasound
Transvaginal Ultrasound
Twenty Four Hour Urine and Spot Ratios
Spot ratios have replaced timed collections for most purposes
Type 1 Versus Type 2 Respiratory Failure
Type 1 is a gas exchange problem, type 2 a ventilation problem
Types of Embolism
Thrombus, fat, air, amniotic fluid, tumour, septic and foreign body
Types of Hypoxia
Hypoxic, anaemic, stagnant and histotoxic
Types of Necrosis
Coagulative, liquefactive, caseous, fat, fibrinoid and gangrenous
Typical Versus Atypical Antipsychotics
Typicals cause movement problems, atypicals cause metabolic ones
Ulnar Nerve Hand Muscles - All But LOAF
All intrinsic hand muscles except the LOAF muscles of the median nerve
Umbilical and Paraumbilical Hernia
Umbilical hernias pass through the ring itself; paraumbilical hernias pass through the linea alba beside it
Umbilical Folds
One median, two medial and two lateral umbilical folds
Upper Limb Dermatome Landmarks
C5 lateral arm, C6 thumb, C7 middle finger, C8 little finger, T1 medial arm
Upper Limb Reflex Roots - 5, 6, 7, 8
Biceps C5 to C6, Supinator C6, Triceps C7 to C8
Upper Versus Lower Motor Neurone Lesions
Upper gives spasticity and brisk reflexes; lower gives wasting and absent reflexes
Urachal Anomalies
Patent urachus, urachal sinus, urachal cyst and bladder diverticulum
Uraemic Syndrome Features
Accumulated toxins affect nearly every system once GFR falls very low
Urea and Electrolytes Interpretation
Sodium, potassium, urea, creatinine and bicarbonate, read together
Ureteric Constrictions
Pelviureteric junction, pelvic brim and vesicoureteric junction
Uric Acid Handling
Filtered, almost completely reabsorbed, then secreted, with net excretion about 10 per cent
Urinalysis Interpretation
Blood, protein, leucocytes, nitrites, glucose and ketones
Urine Concentrating and Diluting Ability
From 50 to 1200 mOsm per kilogram, needing an intact loop, gradient and hormone
Urothelium Structure
Transitional epithelium with umbrella cells and a specialised apical membrane
US - Ultrasound
Ultrasound
Vaccination Principles
Live attenuated give strong lasting immunity; inactivated are safer but need boosters
Vagal Tone at Rest
Intrinsic sinoatrial rate is about 100; resting vagal tone brings it down to about 70
Vagus Branches in the Thorax
Recurrent laryngeal, cardiac, pulmonary and oesophageal branches
Valsalva Manoeuvre Phases
Pressure rise, reduced venous return, release, then overshoot
Valve Lesion Haemodynamics
Stenosis creates a pressure load; regurgitation creates a volume load
VAN
Vein, Artery, Nerve
Varicose Vein Examination
Examine standing, then locate the site of reflux
Vasculitis Classification
Large, medium and small vessel vasculitis, each with characteristic diseases
Vasopressors and Inotropes
Vasopressors squeeze the vessels; inotropes squeeze the heart
Vaughan Williams Classification
Sodium blockers, Beta blockers, Potassium blockers, Calcium blockers
Venous Return Determinants
Mean systemic filling pressure, right atrial pressure and venous resistance
Ventilation Distribution in the Supine Position
Dependent regions receive more ventilation and more perfusion in the spontaneously breathing patient
Ventilation During Exercise
Ventilation rises linearly with work until the anaerobic threshold, then disproportionately
Ventilation-Perfusion Ratio
A ratio of zero is shunt; a ratio of infinity is dead space
Ventilatory Response to Carbon Dioxide
Carbon dioxide is the dominant drive, sensed centrally through cerebrospinal fluid pH
Ventricular Filling Phases
Rapid filling, diastasis and atrial systole
Vernet Syndrome Nerve Trio
Voice breaks, swallowing's a task, shoulder droops, nine ten eleven unmasked
Vertebral Artery Entry Level
Vertebral artery enters at C6, and climbs the transverse foramina all the way up
Vertebral Artery Segments
V1 rises, V2 hides, V3 loops, V4 dives
Vestibular System
Semicircular canals sense rotation; otolith organs sense linear acceleration and gravity
Virchow's Node Clinical Significance
Left Virchow's node signals trouble below
Virchow's Triad
Stasis, endothelial injury and hypercoagulability
Visceral Referred Pain by Gut Segment
Foregut epigastric, midgut periumbilical, hindgut suprapubic
Visual Field Defects
Lesion site determines the pattern, from monocular loss to homonymous hemianopia
Vitamin A Functions and Toxicity
Vision, epithelium and differentiation, with teratogenicity in excess
Vitamin B12 Absorption
Bound by R protein, transferred to intrinsic factor, absorbed in the terminal ileum
Vitamin B12 and Folate Interaction
B12 releases folate from its methylated form
Vitamin C Functions
Collagen hydroxylation, antioxidant activity and iron absorption
Vitamin D Activation
25-hydroxylation in the liver, 1-alpha hydroxylation in the kidney
Vitamin D Metabolism and Actions
Skin to liver to kidney, with calcitriol acting mainly on the gut
Vitamin Deficiencies
Fat-soluble ADEK and the water-soluble B vitamins and C
Vitamin K and Coagulation
Cofactor for gamma-carboxylation of factors II, VII, IX and X plus proteins C and S
Vitelline Duct Anomalies
Meckel's diverticulum, vitelline fistula, sinus, cyst and fibrous band
VO2 Max and Its Determinants
Cardiac output is the main limiting factor, not the lungs
Vocal Cord Mechanics Summary
PCA opens, everyone else closes, CT tightens, TA loosens the noses of sound
Vocal Cord Tension Muscles
CT tightens, TA loosens
Volume of Distribution
The theoretical volume needed to contain the dose at the measured plasma concentration
Vomiting Physiology
Four inputs converge on the vomiting centre in the medulla
Waldeyer's Ring as a Throat Guard
Lingual below, palatine at the sides, tubal by the ears, pharyngeal up high, a ring of guards for the throat
Waldeyer's Ring Components
A ring of guards around the throat
Walls of the Axilla
Anterior, posterior, medial and lateral walls of the axilla
Water and Sodium Balance in Endocrine Disease
Cortisol, aldosterone and antidiuretic hormone disorders each disturb sodium differently
Water Deprivation Test
Deprive water, measure urine osmolality, then give desmopressin
Water Soluble Vitamins
The B group and vitamin C, largely unstored and excreted in urine
Water Under the Bridge
The ureter (water) passes under the uterine artery or vas deferens (the bridge)
Waters View for Sinus Imaging
Waters shows the sinuses, chin up to clear the base
West Zones of the Lung
Alveolar pressure dominates at the apex, arterial pressure at the base
Wharton's Versus Stensen's Duct Memory Aid
Wharton's is under the tongue's floor, Stensen's by the second molar, remember the door
White Cell Differential Interpretation
Neutrophils, lymphocytes, eosinophils, monocytes and basophils
White Cell Types and Functions
Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils
WHO Analgesic Ladder
Non-opioid, then weak opioid, then strong opioid, with adjuvants at every step
Wilson Disease and Haemochromatosis
Wilson accumulates copper; haemochromatosis accumulates iron
Windkessel Effect
Elastic arteries store energy in systole and release it in diastole
Winged Scapula - Medial Versus Lateral
Medial winging from long thoracic nerve palsy, lateral winging from spinal accessory nerve palsy
Work of Breathing
Elastic work plus resistive work, minimised at an optimal respiratory rate
Wound Healing Phases
Haemostasis, inflammation, proliferation and remodelling
Yellow Card Reporting
Any reaction to a black triangle drug, and serious reactions to any drug
Zero Versus First Order Kinetics
First order clears a constant proportion, zero order a constant amount
Zygomaticus Major Smile Line
Zygomaticus major pulls up and out, a diagonal smile without a doubt
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