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).

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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.