Pheochromocytoma

Clinical findings of a pheochromocytoma: 6 P's of Pheochromocytoma
Pressure/Paroxysmal bursts
Pounding Pain (headaches)
Perspiration
Pallor
Panic
Palpitations

Rule of 10's:
10% familial (Men 2a, 2b syndromes)
10% bilateral
10% malignant
10% calcify
10% located outside the medulla (a common site is the bladder. If patient gets episodic hypertension with urination, think about this possibility)

Look for urinary VMA (breakdown of NE) and plasma catecholamines!

Oncology2

Knowing where some cancers metastasize, and what metastases go to which organs, can be important. So I've got a few mnemonics and trends to help me memorize these places and organs associated.

First off, notice that Lung and Breast cancers are involved in all these metastases. They are, in fact, the top cancers. (Lung is the top killer, but breast is the top incidence in women)

Metastasis to the brain:

First Aid uses "Lots of Bad Stuff Kills Glia," but I like using "Cancer: Some Love Killing Brain Glia" ...I don't know why, but I can remember that one better.

Lungs

Breast

Skin

Kidney

GI

Metastasis to the liver:

GI related cancers + your most common cancers (lung and breast). Makes sense with the portal system and all.

Cancer Sometimes Penetrates Benign Liver, most common to least common:

Colon > Stomach > Pancreas > Breast > Lung

*Note that Dr. Goljan (amazing pathologist extraordinaire) says that Lung cancer is the most common, more than all the others. Take that info the way you like. I think I'm gonna go with colon cancer as more likely to metastasize to the liver through the portal circulation, it just makes sense (sorry Dr. Goljan)

Metastasis to the bone:

-Make an association with GU cancers, which are able to access the vertebral column through the batson paravertebral venous plexus. The vertebral column is the most common site of bone metastasis.

P.T. Barnum Loves Kids.

Prostate

Testes

Breasts

Lungs

Kidney

Metastasis to the lungs:

"Real Hardcore Cancers Fill Both My Lungs" (I like to read it HardCore cancers, to remind me the "core" is "choriocarcinomas)

Renal Cell Carcinoma

Hepatocellular Carcinoma (which, btw, is also known as a Hepatoma)

Choriocarcinoma

Follicular Thyroid Carcinoma

Breast

Melanoma

Metastasis FROM the liver

Loves the Adrenals. Also your common ones that receive metastasis get their revenge on the lungs: Breast, Brain, Liver.

Metastasis to the heart

You don't often think about the heart, so I thought I'd just say that Melanoma loves the heart. You also get a lot of Lymphomas metastasizing to the heart. And your two commons: Lung and Breast. Note that metastasis is more common than primary heart cancer.

Whew, that's a lot of mnemonics. Hope you enjoy!

Oncology1

Cancer's a pretty huge subject on the USMLE! I wish I had a mnemonic for all the different tumor suppressors, oncogenes, tumor markers, metastases, cancer associated syndromes, and what not, because they can be so hard to flat out memorize. However, I DO have a few tricks that I've found to be useful, that you may find useful, too.

Keep in mind this is not as high yield as most topics. I'd get a general feel, but to be honest, knowing what chromosome the tumor suppressor genes are on is very low yield. I'm not sure why I memorized it. But I did, so I thought I'd share how I did. If you're just starting on oncology, I'd actually look at oncology2 first. In fact, maybe don't even worry about oncology1. It's my OCD showing through.

Oncogenes


Okay, so you've probably memorized that erb-B2/HER2/Neu is related to breast and ovarian cancer. But did you know that the gene product is a tyrosine kinase? I've seen some questions that actually test on this fact. Now, it may not be worth your time, but if you're wanting to score extraordinarily high, it probably is. Anything extra thing you can know adds fuel to your arsenal against these step 1 questions. So without further adieu, here are some mnemonics and trends I've noticed for oncogenes.

"Able, Tyred (tired) Erb Retired." (I like to read it 'although still able, Erb retired because he was tired')

Tyrosine Kinases:
Abl - CML
Erb-B2 - breast, ovarian
Ret- MEN 2A, 2B

Myc:
all of these are transcription factors. Sorry, just a trend, no good mnemonic.
L-myc: Lungs
N-myc: Neuroblastoma
c-myc: Burkitt's (duh, you've got this one memorized by now. Don't forget t(8, 14)!)

Anti-Apoptosis
bcl-2: follicular lymphoma. Again, you've probably already memorized this, the two are like lamb and tuna fish (or maybe spaghetti and meatballs? Perhaps that's a better analogy?)

c-kit: cytokine receptor. Note also it's a tyrosine kinase receptor.

GTPase:
Ras: colon carcinoma. No good mnemonic for this. Sorry... but you should remember the the Ras is a GTPase involved in signal transduction from biochem. Or maybe it's just me that remembers that. Mmmm mmmmm biochem is AWEsome. Maybe you can think Ras --- GTPase? Now I'm stretching.

Tumor Suppressor Genes (TSG)


No great mnemonic for all of them, and for some reason I made a mnemonic relating to the chromosome that they're on. I had a qbank question that I think scarred (and scared) me into memorizing the chromosomes/tumor suppressor gene associations. This may not be worth your time.

p53: 17p. Note that the TSG's that begin with p will be on the p arm (short arm) of the chromosome. All the rest of the TSG's are on the q arm, except WT1 and VHL (ah, exceptions). Also note, 53 + 17 is a nice round number, 70. Works for me (sorry, some of my math tricks are lame. But when you have to flat out memorize numbers, I guess relating numbers to math is a way that helps).
-Another mnemonic for this to relate it to LI-Fraumeni: Take the LI and rotate it 180 degrees and you should have: 17.

RB: associated with bilateral retinoblastoma and osteosarcomas. On chromosome 13 (break down the initials RB, and highlight the left side of the R and the right side of the B. You get the number 13. Write RB on a piece of paper and you'll see what I mean).

VHL: VHL, 3 letters, 3rd chromosome. (and don't forget, on p arm!)

BRCA1, BRCA2: I just related these to the 2 main TSG's, p53 and Rb, which are 17 and 13. Alphabetically, p53 and Rb are in order, just like BRCA1 and BRCA2. So, BRCA1 is 17, and BRCA2 is 13. Another OCD mnemonic for you.

NF1: again, a lot of these important TSG's seem to be on chromosome 17, as is NF1. Maybe you can make the link that NF1 and BRCA1 are both on 17.
NF2: Take the 2, make 22. Chromosome 22.

p16: 9p. Again, it's on the p arm because it begins with p. And again, we want to add up to a nice number: 16 + 9 = 15. I don't know, multiples of 5 and 10 are just nicer, I guess. Somehow, remember this has to do with Melanoma.

DPC: Deleted in Pancreatic Cancer.
DCC: Deleted in Colon Cancer.
Both of these TSG's are on chromosome 18. Can't think of a good way to make this association.

APC: associated with FAP. Think polyp. 5 letters. Chromosome 5.

WT1: Just like we did for NF2, we take the 1, and make 11. Just write it twice. Also, it's easy to remember this is Wilm's Tumor, right? And RCC (that's also from the kidney, easy association). It's on the p arm!
-----

And that's it! Hope that benefits somebody.

Psammoma bodies

Here's a good mnemonic to figure out which cancers have psammoma bodies (concentric, laminated, calcified spheres):

PPSSaMMoma

Papillary carcinoma of the thyroid (and, if you want more detail, papillary renal cell carcinoma)

Prolactinoma

Serous cystadenocarcinoma of the ovary

Somatostatinoma

Meningioma

Mesothelioma

The somatostatinoma, prolactinoma, and RCC are not as high yield. So you'd be safe with the mneomnic "PSaMMoma"

Wiskott-Aldrich and CGD

Wiskott-Aldrich Syndrome

Think "WAX TIE"

WA: Wiskott-Aldritch

X: X-linked Recessive

T: Thrombocytopenia

I: Infections

E: Eczema

Also, this helps with the immunoglobulins present:

WAX TIE... decreased IgM (think of the W as an upside down M, suggesting a decreased IgM), Increased IgA, Increased IgE

Chronic Granulomatous Disease

I don't have much to say about this, it's lack of NADPH oxidase, leading to increased infections to microbes that have catalase. So what are the catalase organisms? There are questions that are tricky, giving you names of organisms that you don't normally think about. Really, nocardia, aspergillus, and pseudomonas capecia are high yield (since they usually won't give you Staph aureus). So for the catalase positive organisms, remember this:

SNAPE

Staph aureus

Nocardia

Aspergillus

Pseudomonas (capeciae)

E. coli... or generally, Enterobactericiae

Check out my mnemonic on Enterobactericiae if you want to go even more detailed.

Microbiology part2

Just some more random mnemonics of microbiology:

Obligate Aerobes: Nagging Pests Must Breathe
Nocardia
Pseudomonas
Mycobacterium
Bacillus

Anaerobes: Can't Breathe Air (aka your ABC's of anaerobic bacteria)
Clostridia
Bacteroides
Actinomyces

5 bacterial produces transferred by phages: ABCDE
ShigA-like toxin (this is aka Verotoxin)
Botulinum toxin
Cholera toxin
Diphtheria toxin
Erythrogenic toxin (Strep pyogenes)

This last one's not my favorite of mnemonics... especially with that "A" being shigA toxin... but what can you do. Note that Staph aureus' bacterial resistance is also conferred through a phage!

Microbiology part 1

To remember the relevant medical microbial producers of urease, remember:

"Urease PUNCH"

Proteus mirabilis
Ureaplasma urealyticum
Nocardia asteroides
Cryptococcus neoformans
Helicobacter pylori

-----

Actinomyces israelii vs Nocardia asteroides- both are gram +, and form long, branching hyphae, which is characteristic.

So what differentiates them? Actinomyces is anaerobic, colonizes mouth and vagina normally, and causes abscesses that drain with sulfur granules.  Nocardia is aerobic, lives in water and soil, and causes cutaneous (through trauma), respiratory, or disseminated (e.g. brain/meningeal, kidney) involvement. Only the cutaneous problems are seen in immunocompetent people.

Treatments: SNAP

SMX/TMP - Nocardia
Actinomyces - Penicillin G

Actinomyces israelii: There is a lot of sand in Israel. The yellow sulfur granules look like sand.

Nocardia asteroides: Asteroids are foreign to Earth, just like this bacteria is foreign to the human body (not grown in normal flora)

Enterobactericiae

Enterobactericiae are oxidase negative, facultative anaerobes that ferment glucose and convert Nitrates to Nitrites. A famous one is E. coli.

There are two classes to divide these guys. The ones that ferment lactose, and the ones that don't. The ones that do ferment lactose turn McConkee's agar pink. The nonlactose fermenters are clear on McConkee's agar.

Lactose fermenters:
McConKEES

Citrobacter
Klebsiella
E. coli
Enterobacter
Serratia marcescens

Non-lactose fermenters:
ShYPS (Ships)

Shigella
Yersinia enterocolitica
Proteus mirabilus
Salmonella

This isn't quite complete, but it's about as much as you'll need to know, as there are a few others, but they're bacteria that aren't typically considered high yield.

Steroid Toxicities

Toxicities of Prednisone/Corticosteroids:

Don't have a clever way to remember this one, just kind of do...

"CHIP CHOPA"

Cushingoid Changes
Hypertension
Immunosuppression
Psychosis (steroid related)

Cataracts
Hyperglycemia
Osteoporosis
Peptic ulcers
Acne

They also say that Cortisol is BBIIG, which may help you remember its functions, and tie it in with toxicities:

Blood pressure increased
Bone formation decreased
Immunosupression
Inflammatory retardant
Gluconeogenesis, lipolysis, proteolysis

Not one of my favorite mnemonics but it does give you a hint at some of the toxicities.

Anion Gap Metabolic Acidosis

Many people use the good old MUDPILES mnemonic, but I found one that I like more, that's more inclusive:

"CUTE DIMPLES"

Cyanide
Uremia
Toluene
Ethanol

Diabetic Ketoacidosis
Isoniazid and Iron
Methanol
Propylene Glycol, Phenformin, Paraldehyde (the last 2 aren't really used anymore)
Lactic Acidosis
Ethylene Glycol
Salicylates

Cranial Nerves

There are many mnemonics for cranial nerves, but for some reason, the dirties mnemonics always stick. Here are 2; the first is to memorize the order of the cranial nerves and their names (I-XII), and the second is to categorize them as motor, sensory, or both (M, S, or B)

"Oh, Oh, Oh, To Touch And Feel Virgin Girls' Vaginas And Hymens"

"Some Say Money Matters, But My Brother Says Big Boobs Matter More"

S- Olfactory
S- Optic
M- Occulomotor
M- Trochlear
B- Trigeminal
M- Abducens
B- Facial
S- Vestibulocochlear
B- Glossopharyngeal
B- Vagus
M- Accessory
M- Hypoglossal

Rashes of Microbiology

Just a few helpful rash mnemonics...

The 5 most common organisms of red rash in pediatric patients:

"Really Red Munchkins Scare Parents"

Rubella, Roseola, Measles, Scarlet Fever, Parvovirus B19

And don't forget your poxes! (chickenpox aka varicella-zoster, and poxvirus). While I'm at it, poxvirus is shaped like a box (pox in a box)... this is the capsid, pox doesn't have an envelope.

I might as well describe the different presentations of the 5 most common pediatric rashes:

Rubella: aka the 3 day measles, begins with a fever followed by a 3 day descending rash, starting at the head and working its way down (just like measles). Infamous intrauterine infection, affecting heart (Patent Ductus Arteriosus), eyes (cataracts), and CNS (microcephaly, sensorineural deafness). Noted for postauricular and cervical lymphadenopathy in the mom.

Roseola: very high fever (most common cause of pediatric seizures), macular rash appears after several days, starts on trunk (vs. parvovirus).

Measles: aka Rubeola, presents with the 4 C's: Cough, Conjunctivitis, Coryza (general flu symptoms), and Koplik's spots (okay, it's not a C, but still). Koplik's spots are red lesions in throat mucosa. 3 major complications that can occur are pneumonia, encephalitis, and, several years down the line, Subacute Sclerosing Panencephalitis, in which the white and gray matter of the brain is damages. And of course, the notorious rash that progresses from head to feet (about a week).

Scarlet Fever: from S. pyogenes. Erythematous, sandpaper-like rash with fever and sore throat. Strawberry tongue within first 2 days, desquamating rash on palms and soles afterwards.

Parvovirus B19: "slapped-cheek" lacy rash that follows fever. Lyses erythroblasts in bone marrow, leads to transient aplastic crisis in hosts that have increased erythropoiesis (e.g. sickle cell, thalassemias).

-----

In microbiology, there are 3 organisms that cause rash specific to the palms and soles, and you can remember them by the following mnemonic:

"You drive CARS with your palms and soles"

CA- Coxsackievirus A

R- Rickettsia Rickettsii

S- Syphilis (secondary)

Note that staph aureus and strep pyogenes can also cause a desquamating rash on the hands. And keep in mind, there are plenty more rashes, not specific to microbiology, for example, kowasaki's presents with a rash on the hands.

Cold Agglutinins

Cold agglutinins are clinically relevant antibodies that are implicated in intravascular hemolysis. At normal body temperature, these antibodies do not cause hemolysis. However, when RBCs get out into the periphery and temperatures drop, the antibodies can attach to red blood cells, causing hemolysis primarily through the complement system. They are called cold agglutinins because when they are placed in cold temperatures in a laboratory setting, the antibodies will attach to RBCs and cause agglutination.

Remember the 3 M's of cold Agglutinins:
IgM
Mycoplasma pneumoniae (can trigger cold agglutinins)
Mononucleosis (EBV, CMV infection)

Warm agglutinins are caused by IgG. To remember the difference, you can remember that
"Maine is colder than Georgia."

K+ sparing diuretics

How do you get your potassium? Potassium Sparing Diuretics

"Some EAT bananas" (as in some people eat bananas to get potassium? Maybe? No?)

Spironolactone, Eplerenone, Amiloride, Triamterene

Background: act in the distal collecting tubules
S and E: block the cytoplasmic steroid receptor for aldosterone.
A and T: block the sodium channel (ENaC) that is upregulated by aldosterone

By the way, the aldosterone receptor is a zinc finger. It'll go into the nucleus and bind DNA to induce transcription. Did you know that? Probably not that high yield, but it's important to remember to tie concepts like that together!

Heart Auscultation

"All Patients Trust Me" - Aortic, Pulmonic, Tricuspid, Mitral

When listening for abnormalities, auscultate in these areas:

Aortic: right sternal, 2nd intercostal space

Pulmonic: left sternal, 2nd intercostal space

Tricuspid: left sternal, 4th intercostal space

Mitral: left midclavicular (near PMI), 5th intercostal space

2 things you should figure out:

1) Is it a R or L heart problem? R-sided heart sounds increase intensity with inspiration (you suck more blood into the right heart from the system, exacerbating heart sounds). L-heart sounds increase intensity with expiration.

2) Is it systolic or diastolic? Systolic is (as you well know) increased pressure in the ventricle due to ventricular contraction. Valvular defects that manifests: AV valves forced to close (Mitral/Tricuspid regurgitation audible), and blood must be pumped through aortic or pulmonic valves (Aortic/Pulmonic stenosis audible). Diastolic heart sounds are the opposite.

Also, did you know that the S1 and S2 heart sounds are not actually the sound of the valves closing, but the sound of turbulent blood flow hitting the valves AFTER they closes? I thought that was interesting.

Adrenal Cortex Layers

Think of an adrenal gland chilling on a kidney in a swim suit, drinking a margarita...

When drinking a margarita, you get "salt, sugar, then sex... the deeper you go, the sweeter it gets!"

Also, it's on the kidney, so it can observe the "GFR" - corresponds to the layers of the cortex.

Adrenal cortex layers from most superficial to deep:

Zona Glomerulosa: produces aldosterone

Zona Fasciculata: produces mostly cortisol

Zona Reticularis: produces mostly androgens

DiGeorge Syndrome

DiGeorge Syndrome. Main problem is related to the immune system, due to aplasia of the thymus (T cells are unable to mature). The parathyroid glands are also generally absent, leading to problems with calcium absorption and maintenance (no PTH). The syndrome is commonly due to a deletion on chromosome 22 (22q11.2). Though the syndrome can have a spectrum of symptoms, you can memorize the general symptoms with this mnemonic:

CATCH-22

Cardiac Abnormalities (especially Tetralogy of Fallot)
Abnormal Facies
Thyroid aplasia
Cleft Palate
Hypocalcemia
-
22: found on chromosome 22

Learning: Acid-Base Disorders

I always had trouble with Acid-Base Disorders, so I thought I'd share this. People always say that they're not too difficult if you know what you're doing. Sure you can look at the pH, but how do you tell if the offense is a metabolic acidosis vs. a respiratory acidosis?

First of all, you're dealing with pH, PCO2, and bicarbonate.

1. Look at the pH. Is it low or high? High pH= alkalosis. Low pH = acidosis.

2. Now all you have to do is figure out which organ (lungs or kidney) is messing up and causing the pH dysfunction. For example, let's say we have a low pH. What can cause that? Either low bicarbonate or high PCO2. Note: you will never have both. So if you have a low bicarbonate, you will have a low PCO2, and visa versa. You can take my word for it, or you can see the explanation below(*). Now all you have to do is look at which one corresponds to the pH level. If you have a low pH and you have a low bicarbonate, you KNOW it's the kidney that isn't making enough bicarbonate to balance all that acid. Thus, metabolic acidosis. If you have low pH and high PCO2, you know that your lungs are messing up, making it a respiratory acidosis. Essentially the name of the disorder (i.e. respiratory acidosis) refers to the organ that isn't functioning properly (lungs in this case) and the pH value (acidosis in this case).

Just two steps. Not too shabby.

*here's an example to understand. If you have a low pH (acidosis), you're really just asking what causes it. The other organ, either the lung or the kidney, is going to try to compensate for that lack. So again, low bicarbonate is causing the acidosis, your lungs are going to try to compensate by expelling out CO2 (decreasing PCO2). Reason your way through this with any scenario. Another example if you're still confused: if you have a respiratory alkalosis, that means your lungs are messing up (low PCO2 gives you a high pH) and thus your kidneys will try to compensate by decreasing the bicarbonate.

Lead Poisoning

Lead Poisoning Clinical Presentations:


Just remember ABCDEFGH (I remember it as "A-GGHH! Lead poisoning!")

1. Anemia. Pb denatures enzymes (ferrochelatase, ALA dehydrase) leading to ringed sideroblasts (faulty heme synthesis, iron accumulates in mitochondria of RBC progenitors)
2. Basophilic stippling. Pb also degrades ribonuclease, which degrades ribosomes. Mature RBCs normally have no ribosomes.
3. Colic w/ Diarrhea. (lead deposits in GI tract. Can visualize with radiographic image)
4. Encephalopathy in children. δ-ALA accumulates, increasing vessel permeability (edema) and causing demyelination. Often presents as headaches and memory loss in adults
5. Foot drop. More specifically, peripheral neuropathy. Consequences: foot drop (perineal nerve palsy), wrist drop (radial nerve palsy), claw hand (ulnar nerve palsy)
6. Growth retardation and Gum deposition. Pb accumulates in epiphyses, causing growth retardation and increased densities on bone radiograph. Pb also lines your gums.
7. Pb causes Nephropathy. This can lead to impaired uric acid secretion (Gout/Hyperuricemia) and Hypertension

Fact of the Day: CO2 transport to the lungs

Fact:

When the tissues give of CO2 after undergoing metabolic oxidation, the CO2 enters into RBCs. This CO2 + H2O (with the help of carbonic anhydrase**) is converted into HCO3- and H+. The HCO3- is exchanged for Cl- (chloride shift), and drifts out into the plasma. This explains why the major form of CO2 is HCO3-! (80-90%)

So now the RBC is stuck with H+ in its cytoplasm. It turns out hemoglobin is a good buffer, but only in the deoxyhemoglobin form. Luckily, most of the O2 attached to hemoglobin has been released into the peripheral tissues, leaving a majority in the deoxyhemoglobin form, which readily attaches to H+.

When the RBC makes it to the lungs, the opposite happens. HCO3- is exchanged back into the RBC for Cl-, combines with H+ (again, with the help of carbonic anhydrase**), and reforms CO2 + H2O. The CO2 happily diffuses out into the alveolus, and the O2 enters back into the RBC to oxygenate hemoglobin.

So note, Cl- plays a crucial role in CO2 transport to the lungs.

**Technically, carbonic anhydrase is used for H2O + CO2 <--> H2CO3, and H2CO3 readily dissociates into HCO3- and H+

G-protein coupled receptors

G-protein coupled receptors (GPCRs) are essential for many processes. What receptors are GPCRs?

Before I get into this further, I must say that sometimes it's the dirty mnemonics that you remember best. That being said, I've created a mnemonic to memorize which receptors are GPCRs.

"Αlpha and βeta Males Don't Hate Vagina."

Receptors: Alpha, Beta, Muscarinic, Dopamine, Histamine, Vasopressin.

More facts you will need to memorize are to what class the G proteins belong. That is to say, if the G proteins that are coupled to the receptors are Gs (stimulatory), Gi (inhibitory), or Gq. Gs and Gi use Adenylate Cyclase as their effector and Calcium as their second messenger, while Gq receptors use Phospholipase C as their effector and IP3 and DAG as their second messengers.

Here is an easy mnemonic. Important: line up the receptors according to the above mnemonic (Alpha and Beta Males Don't Hate Vagina)

"qiss and qiq til you're siq of sqs" (kiss and kick til you're sick of sex)

α1   -   q
α2   -   i
β1   -   s
β2   -   s

M1  -   q
M2  -   i
M3  -   q

D1  -   s
D2  -   i
H1  -   q

H2  -   s
V1  -   q
V2  -   s

2 mnemonics for the price of one. Awesome.

Fact of the Day: Kids Hb Count

Fact:

Children have a lower hemoglobin count than adults (<11.5 g/dL is anemic).

Why is this? They have a higher serum phosphate, assumably from the increase in bone growth* and an increased metabolism in general. This higher phosphate leads to increased levels of 2,3 BPG, which we know causes a right shift in the O2 saturation curve. This means more oxygen is dumped into the tissues per hemoglobin molecule. Thus, less hemoglobin is required to transfer oxygen to the tissues.

*the main inorganic material of bone, hydroxyapatite, utilizes 10 Ca for every 6 Phosphorous (Ca10(PO4)6(OH)2). This leaves an excess of Phosphorous (since Calcium and Phosphorous usually come together in the form of CaPO4)

Mnemonic: Encapsulated Organisms

"YES, Some Killers Have Pretty Nice Capsules"

Yersinia Pestis (F1 capsule)

E. coli (some species)

Strept Agalactiae

Strept Pneumoniae

Klebsiella

Haemophilus Influenzae

Pseudomonas Aeruginosa

Neisseria Meningitidis

Cryptococcus Neoformans

Note there are other encapsulated species, but not as important. However, one to remember is Bacillus Anthracis, because unlike other bacteria, it has an amino acid (D-glutamate) capsule!

Important Notes:

Children are more susceptible to bacteria with polysaccharide capsules, because they do not have the proper antibodies against these organisms.

Asplenic patients are more susceptible to encapsulated pathogens. Watch out for functional asplenic patients with Sickle Cell Anemia! (Don't forget those Howell-Jolly bodies in asplenic patients!)