Step 1 Mnemonics I: Behavioral, Biochem, Embryo, Micro

High yield mnemonics for USMLE Step 1
STUDY
PLAY
SpIN, SnOUT
Specificity - used to rule dz IN (good for diagnostic tests)
Sensitivity - used to rule dz OUT (good for screening tests)
Mr. T is mean
t-test checks difference btwn the means of 2 grps
ANOVA
ANalysis Of VAriance - btwn means of 3 or more groups
PDR
Disease prevention:
P - prevent - primary (HPV vaccination)
D - detect - secondary (Pap smear)
R - reduce disability - tertiary (chemotherapy)
APGAR
10-point scale evaluated at 1 minute and 5 minutes of life in newborn:
Appearance
Pulse
Grimace
Activity
Respiration
Death Arrives Bringing Grave Acceptance
Kubler Ross grief stages:
Denial, Anger, Bargaining, Grieving (depression), Acceptance
BATS Drink Blood
Sleep Stages:
Beta (Awake; highest frequency, lowest amplitude)
Alpha (Awake, eyes closed)
Theta (light sleep)
Sleep spindles and K complexes (bruxism)
Delta (Deepest; slowest frequency, highest amplitude; enuresis)
Beta (REM; same frequency as awake!)
He's Got Purine Recovery Trouble
HGPRT - the defective E in Lesch-Nyhan syndrome
XR; excess urate, retardation, self-mutilation (lip-biting), gout.
Tx - allopurinol
Rampant, Massive, Tiny
RNA types:
Rampant - rRNA - most abundant - RNA pol I
Massive - mRNA - longest - RNA pol II
Tiny - tRNA - smallest - RNA poll III
U Go Away, U Are Away, U Are Gone
mRNA stop codons:
UGA
UAA
UAG
going APE
Ribosome sites, in order:
A site - incoming Aminoacyl tRNA
P site - accommodates growing Peptide
E site - holds Empty tRNA as it Exits
PMAT
Mitosis phases:
Prophase
Metaphase
Anaphase
Telophase
Be So Totally Cool, Read Books
Collagen types:
I - Bone, Skin, Tendon (cornea, late wound repair)
II - Cartilage (including hyaline)
III - Reticulin (skin, blood vessels, uterus, granulation)
IV - Basement Membrane
Type IV: under the floor
Type IV collagen - basement membrane
strong, slippery, bloody BM
Collagen types:
I - strong
II - slippery
III - bloody
IV - basement membrane
SNoW DRoP
Blotting: procedures, sample, (probe)
S - southern, DNA (DNA)
N - northern, RNA (DNA)
W - western, Protein (Ab)
Be Wise, Fool's GOLD Heeds Silly Hope
X-linked recessive disorders:
B - Bruton's agammaglobulinemia
W - Wiskott-Aldrich
F - Fabry's
G - G6PD deficiency
O - ocular albinism
L - Lesch-Nyhan
D - Duchenne's MD (and Becker's)
HS - Hunter's Syndrome
H - Hemophilia A & B
WBC
X-linked immunodeficiencies:
W - Wiskott-Aldrich
B - Bruton's agammaglobulinemia
C - Chronic Granulomatous disease
(and some types of Hyper-IgM)
Try hunting for my fried eggs
Trinucleotide repeat diseases:
Huntington's (CAG)
MyoTonic dystrophy (CTG)
Fragile X (CGG)
Friedreich's AtAxia (GAA)
Drink, Elect, Puberty
Autosomal trisomies:
Drink at 21 - Down's (epichantal folds, simian crease)
Elect at 18 - Edward's (micrognathia, clenched hands)
Puberty at 13 - Patau's (cleft lip/Palate, holoProsencephaly, Polydactyly)
CATCH-22
Symptoms of 22q11 deletion syndromes:
C - Cleft palate
A - Abnormal facies
T - Thymic aplasia --> T cell deficiency
C - Cardiac defects
H - Hypocalcemia - 2'ary to parathyroid aplasia

DiGeorge Syndrome - thymic, parathyroid, cardiac
Velocardiofacial - palate, facial, cardiac
BOTH - d/t aberrant dev of 3rd & 4th branchial pouches
The Rich Never Pan Pyrite Filled Creeks
Water soluble vitamins:
B1 - Thiamine (TPP)
B2 - Riboflavin (FAD, FMN)
B3 - Niacin (NAD)
B5 - Pantothenate (CoA)
B6 - Pyridoxine (PLP)
(B7 - biotin)
B9 - Folate (THF)
B12 - Cobalamin
(Vitamin C (ascorbic acid))
Tender Loving Care For No one
Cofactors for PDH, alpha-ketoglutarate dehydrogenase:
T - thiamine/TPP
L - lipoic acid
C - CoA
F - FAD
N - NAD
3 D's
3 D's of Pellagra (niacin deficiency):
Diarrhea, Dermatitis, Dementia

NAD from niacin (3 ATP)
2 C's
2 C's of riboflavin deficiency:
Cheilosis (inflamm of lips, angular stomatosis)
Corneal vascularization

FAD and FMN are derived from riboFlavin - 2 ATPs
SAM the methyl donor man
S-adenosyl-methionine:
Transfers methyl units
Regenerates methionine, in a B12 and folate-dependent process using Homocysteine Methyltransferase

Required for conversion of NE --> Epi
Buy-a-tin of CO2
Biotin (B7) - cofactor for carboxylation reactions:

Pyruvate carboxylase (glycolysis)
ACC (rds of FA synthesis)
Propionyl-CoA carboxylase
AVIDin in egg whites AVIDly binds biotin
Rare deficiency of biotin, can be caused by excessive ingestion of raw eggs
E for Erythrocytes
Vitamin E - antioxidant that protects rbc membranes from free radical damage

Aka - alpha-tocopherol (sp)
Deficiency --> hemolytic anemia
ADEK
Fat-soluble vitamins.
Toxicity more common b/c they accumulate in fat
MEAL
Kwashiorkor results from a protein-deficient MEAL:
M - Malnutrition
E - Edema (swollen belly)
A - anemia
L - Liver (fatty - can't make apoproteins -> can't export VLDLs)

Vs. marasmus, which is decreased overall caloric intake --> m. wasting
HUGs take two
Metabolism sites occurring in both cytoplasm and mitochondria:
H - Heme synthesis
U - Urea cycle
G - Gluconeogenesis
Citrate Is Krebs Starting Substrate For Making Oxaloacetate
TCA cycle:
Citrate
Isocitrate
Ketoglutarate (alpha)
Succinyl-CoA
Succinate
Fumarate
Malate
Oxaloacetate
Pathway Produces Fresh Glucose
Gluconeogenesis E's:

P - Pyruvate carboxylase (mitochondria, biotin)
P - PEP carboxykinase (cytosol, GTP)
F - Fructose-1,6-bisphosphatase (cytosol, rds)
G - Glucose-6-phosphatase (ER)
PriVaTe TIM HALL
Essential Amino Acids:
PriVaTe - Phe, Val, Trp
TIM - Thr, Ile, Met
HALL - His, Arg, Leu, Lys
Very Poor Carbohydrate Metabolism
Glycogen storage diseases (type I, II, III, V):

V - Von Gierke's (glucose-6-phosphatase; lactic acid)
P - Pompe's (lysosomal alpha-1,4-glucosidase)
C - Cori's (debranching enzyme = alpha-1,6-glucosidase)
M - McArdle's (skeletal m. glycogen phosphorylase)
No man picks his nose with his sphinger
Neimann-Pick disease.
Deficiency of sphingomyelinase -->
buildup of sphingomyelin
Young Liver Synthesizes Blood
Fetal erythropoiesis:

Y - Yolk sac (3-8 wk)
L - Liver (6-30 wk)
S - Spleen (9-28 wk)
B - Bone Marrow (wk 28 -->)

Fetal Hb = 2 alpha, 2 gamma - dec affinity for 2,3-DPG --> increased affinity for oxygen
CAP covers out to in
Branchial apparatus derivatives:
C - Clefts = ectoderm
A - Arches = mesoderm
P - Pouches = endoderm
Several Parts Build Diaphragm
Diaphram embryology:

S - septum transversum --> central tendon
P - Pleuroperitoneal folds
B - Body wall
D - dorsal mesentery of esophagus --> crura
Babies who can't Pee in utero develop ___
Potter's syndrome
Malformation of ureteric bud --> bilateral renal agenesis --> oligohydramnios --> limb & facial deformities, pulmonary hypoplasia
Kapsules Shield SHiN
Encapsulated bacteria (positive quellung rxn):

K - Klebsiella pneumoniae
S - Salmonella
S - Streptococcus pneumoniae
Hi - Haemophilus influenzae, type B
N - Neisseria meningitidis

SHiN - produce IgA protease, cause meningitis, and take up DNA from environment (transformation)
anaerobes Can't Breathe Air
Obligate anaerobes:

C - Clostridium
B - Bacteroides
A - Actinomyces

Lack catalase and/or superoxide dismutase --> susceptible to oxidative damage

Tx - Clindamycin, metronidazole
stay inside when it's Really Cold
Obligate intracellular bacteria:

R - Rickettsia
C - Chlamydia

Can't make own ATP
Some Nasty Bugs May Live FacultativeLy
Facultative Intracellular bacteria:

S - Salmonella
N - Neisseria
B - Brucella
M - Mycobacterium
L - Listeria
F - Francisela
L - Legionella
PHUK, I have a stone
Urease-positive bugs (may --> stones):

P - Proteus
H - H. pyori
U - Ureaplasma
K - Klebsiella

Dx - urea breath test?
Israel has yellow sand
Actinomyces isrealii -> yellow "sulfur" granules
Nagging Pests Must Breathe
Obligate aerobes (use an oxygen-dependent system to generate ATP):

N - Nocardia
P - Pseudomonas aeruginosa
M - Mycobacterium tuberculosis
B - Bacillus
These Rascals May Microscopically Lack Color
Bugs that don't stain well on Gram stain:

T - Treponema (too thin; use darkfield)
R - Rickettsia (intracellular parasite)
M - Mycobacteria (high lipid-content of cell wall requires acid-fast stain)
M - Mycoplasma (no cell wall)
L - Legionella pneumophila (use silver stain)
C - Chlamydia (intracellular parasite; lacks muramic acid in cell wall)
PASs the sugar
Periodic Acid-Shiff stain
Stains glycogen
Used to diagnose Whipple's disease (Tropheryma whippelii)
ABCDE
Genes for 5 bacterial toxins encoded in lysogenic phage:

A - ShigA-like toxin
B - Botulinum toxin
C - Cholera toxin
D - Diphteria toxin
E - Erythrogenic toxin - S. pyogenes
MOPS
Streptococcus pneumoniae:
Most OPtochinin Sensitive

Most common cause of:
M - Meningitis
O - Otitis media (children)
P - Pneumonia
S - Sinusitis

Encapsulated. IgA protease. Transformation. Diplococcus
"rusty sputum"
ABCDEFG
Corynebacterium diphtheriae exotoxin:

A - ADP ribosylation
B - Beta prophage (encoded by)
C - Corynebacterium
D - Diphtheriae
E, F - Elongation Factor 2
G - Granules (metachromic blue and red)

ADP ribosylation of EF-2 inhibits protein synthesis.
Lactose is KEE
MacConKEE's agar
Media used to grow lactose fermenters (pink colonies)
Fast fermenters:

K - Klebsiella
E - Enterobacter
E - E. coli
HaEMOPhilus influenzae
H. influenzae causes:

E - Epiglottitis ("cherry red", "thumb sign" on XRay)
M - Meningitis
O - Otitis Media
P - Pneumonia

Does NOT cause the flu!
PSEUDOmonas
Pseudomonas a/w:

P - Pneumonia
S - Sepsis (black lesions on skin)
E - External otitis (swimmer's ear)
U - UTI
DO - Drug use and Diabetic Osteomyelitis

+ burn victims, contact lens infection
Tx - 2 abx = gentamycin + piperacillin
4 A's
Klebsiella:

Aspiration pneumonia
Abscesses in lung
Alcoholics
di-A-betics

"red currant jelly sputum"
"Can't see, can't pee, can't climb a tree"
Reiter's syndrome
BAKE a key Lyme pie
Lyme disease (Borrelia burgdorferi, Ixodes tick)

B - Bell's palsy (can be bilateral)
A - Arthritis
K - Kardiac block (AV node)
E - Erythema chronicum migrans (expanding "bull's eye" red rash with central clearing)

Tx - doxycycline, or ceftriaxone (for chronic arthritis)
"I don't have a clue why I smell fish in the vagina garden!"
Gardnerella vaginalis
Vaginosis with gray discharge, fishy smell, clue cells (covered with bacteria)

Tx - Metro
Rickettsia on the wRist, Typhus on the Trunk
Rickettsia (RMSF) - starts on hands and feet

Typhus rash starts centrally then spreads, without involving the palms or soles.
Q fever is Queer
Caused by Coxiella burnetii (does not have Rickettsia in genus name)

No rash, no vector, negative Weil-Felix
You drive CARS using your palms and soles
Palm and sole rash seen in:

CA - Coxsackievirus A (hand, foot, mouth dz)
R - RMSF - Rickettsia rickettsii
S - Syphilis
You'll get sick if you EAT these
Nematode route of infection - Ingestion:

E - Enterobius (anal pruritis, Scotch tape test)
A - Ascaris (Loeffler's eosinophilic pneumonitis)
T - Trichinella (undercooked pork, larvae encyst in muscle, periorbital edema)
These get into your feet from the SANd
Nematode route of infection - Cutaneous

S - Strongyloides
A - Ancylostoma (iron deficiency anemia)
N - Necator (iron deficiency anemia)
"Live small yellow chickens get vaccinated with Sabin's and MMR!"
Live attenuated vaccines:

Smallpox, Yellow fever, Chickenpox (VZV), Sabin's polio virus, MMR, (and intranasal influenza)
RIP Always
Killed vaccines:

R - Rabies
I - Influenza
P - Salk Polio
A - HAV
"part-of-a-virus"
All DNA viruses are dsDNA (like our DNA), except Parvovirus - ssDNA

parvus = small
"repeatovirus"
All RNA viruses are ssRNA (like our mRNA), except Reovirus - dsRNA
Naked CPR and PAPP smear
Naked (nonenveloped) viruses include:

CPR - Calcivirus, Picornavirus, Reovirus
PAPP - Parvovirus, Adenovirus, Papilloma, Polyoma
DNA viruses are HHAPPPPy
Hepadna
Herpes
Adeno
Pox
Parvo
Papilloma
Polyoma
Get Herpes in a CHEVrolet
Herpesviruses:

C - CMV
H - HSV (-1 -> temporal lobe encephalitis)
E - EBV
V - VZV - remains dormant in trigeminal and DRG
PaRaMyxovirus:
Paramyxoviruses: enveloped, ss, linear, nonsegmented RNA viruses:

Parainfluenza - (croup)
RSV - (bronchiolitis in babies)
Rubeola (Measles)
Always Bring Polymerase Or Fail Replication
Negative stranded viruses.
Must transcribe negative strand to positive. Virion brings its own RNA-dependent RNA pol.

Arenaviruses, Bunyaviruses, Paramyxoviruses, Orthomyxoviruses, Filoviruses, Rhabdoviruses
BOAR
Segmented viruses. All are RNA viruses.

B - Bunyaviruses
O - Othormyxoviruses (influenza viruses)
A - Arenaviruses
R - Reoviruses

Influenza viruses can undergo Ag shift --> worldwide pandemics
PERCH on a "peak" (pico)
PicoRNAviruses = small RNA viruses. Include:

P - Poliovirus
E - Echovirus
R - Rhinovirus
C - Coxsackievirus
H - HAV

RNA is translated into one large polypeptide that is cleaved by proteases into functional viral proteins.
ROTA - Right Out The Anus
Rotavirus - the most important global cause of infantile gastroenteritis.

Segmental dsRNA (reovirus).

Major cause of acute diarrhea in U.S. during winter.

Villous destruction w atrophy --> dec absorption of Na+ and water.
3 C's of Measles
Cough
Coryza (runny nose)
Conjunctivitis

Koplik's spots (red spots with blue-white center on buccal mucosa).

Rash spreads from head to toe.
Parotid glands and testes as big as POM-poms
Mumps virus.

P - Parotitis
O - Orchitis (inflamm of testes)
M - aseptic Meningitis
Asymptomatic, Acute, Alone (virus)
HAV - often asymptomatic, not chronic, no carriers
Defective, Dependent (virus)
HDV - defective - requires HBsAg as its envelope
Enteric, Expectant (mothers, Epidemics (virus)
HEV - fecal-oral; high mortality in pregnant women
4 Fs's
Stages of HIV infection.

1. Flulike (acute)
2. Feeling fine (latent, few years)
3. Falling CD4 count (opportunistic infections)
4. Final crisis
Runts May Cough Sputum
Most common causes of pneumonia - children 4 wk - 18 year:

R - RSV
M - Mycoplasma
C - Chlamydia pnemoniae
S - Strep pneumoniae
"Food poisoning from reheated rice? Be serious!"
Bacillus cereus
SSEEK PP
UTI bugs:

Serratia marcescens
Staph saprophyticus
E. coli (#1 cause)
Enterobacter cloacae
Klebsiella pneumoniae
Proteus
Pseudomonas
ToRCHHeS
Congenital infections: microbes pass from mother to fetus:

T - Toxoplasma gondii - (cat feces, intracranial calcifications)
R - Rubella - (heart dz, cateracts, deafness)
C - CMV - (unilateral hearing loss + toxo S/S)
H - HIV - (prevent with Zidovudine, HAART, C-sxn)
H - HSV - (temporal lobe encephalitis)
S - Syphilis - (stillbirth, hydrops fetalis, rash (desquamation of hands and feet), facial abnorm's - notched teeth, saddle nose, saber shins)

Also, parvovirus B19 --> hydrops fetalis
Wind, water, wound, walking, wein, wonder
Causes of post-op fever:

Wind - atelectasis, penumonia
Water - UTI's
Wound - wound infection
Walking - DVT's
Wein - thrombophlebitis
Wonder - wonder drugs (antibiotics - iatrogenic)
Aminopenicillins HELPS kill enterocci
Ampicillin/amOxicillin (Oral) kills certain G+ bacteria and G- rods:

H- H. influenzae
E - E. coli
L - Listeria
P - Proteus
S - Salmonella

Indications: UTI's, neonatal infections
TCP Takes Care of Pseudomonas
Ticarcillin
Carbenicillin
Piperacillin

Same mech as penicillin; use clavulinic acid.
"We're ECSTaTiC about bacteriostatics"
Erythromycin
Clindamycin
Sulfamethoxazole
Trimethoprim
Tetracyclines
Chloramphenicol
Very Finely Proficient At Cell Murder
Bactericidals:

Vancomycin
Fluoroquinolones
Penicillin
Aminoglygosides
Cephalosporins
Metronidazole
PEcK
Organisms covered by 1st generation cephalosporins:

G+ cocci, plus:
Proteus
E. coli
Klebsiella
HEN PEcKS
Organisms covered by 2nd gen cephalosporins

G+ cocci, plus:

Haemophilus influenzae
Enterobacter
Neisseria

Proteus
E. coli
Klebsiella
Serratia marcescens
the kill is LASTIN' with ciLASTATIN
Add cilastatin to imipenem to inhibit metabolism by renal dihydropeptidase I

Meropenem does not need cilastatin.

Coverage: G-rods, G+cocci, anaerobes
"Big guns"
Has some, but NOT many toxicities
Vancomycin:

Nephrotoxic
Ototoxic
Thrombophlebitis

Red Man Syndrome - px with pretreatment with antihistamines and slow infusion rate.
Buy AT 30, CCELL (sell) at 50
Bacterial Protein Synthesis Inhibitors:

30S
A - Aminoglycosides (GNATS, bactericidal)
T - Tetracyclines (bacteriostatic; px attachment of aminoacyl tRNA)

50S
C - Clindamycin, Chloramphenicol (bacteriostatic)
E - Erythromycin (macrolides - azithromycin, clarishromycin - bacteriostatic - bind 23S rRNA of 50S, block translocation)
L - Lincomycin (bacteriostatic)
L - Linezolid (binds 23S rRNA, block initiation complex)
GNATS canNOT kill anaerobes
Aminoglycosides

G - Gentamycin
N - Neomycin
A - Amikacin
T - Tobramycin
S - Streptomycin

N - Nephrotoxic - esp w cephalosporins
O - Ototoxic - esp w loops
T - Teratogen

Can kill aerobes (bactericidal), but require oxygen for uptake --> can't kill anaerobes

MECH - bind 30S, inhibit formtion of initiation complex and cause misreading of mRNA
VACUUM THe BedRoomS
Clinical use of tetracylines:

V. cholera, Acne, Chlamydia, Ureaplasma, Urealyticum, Mycoplasma pneumoniae, Tularemia, H. pylori, Borrelia burgdorferi, Rickettsia, SIADH (demeclocycline)

Tetracycline, doxycycline, demeclocycline, minocycline

MECH - bind 30S --> prevent attachment of aminoacyle tRNA

Must not take with milk, antacids, or iron - divalent cations inhibit GI absorption

TOX - teratogen (bone, cartilage), discolors teeth, inhibition of bond growth in children, photosensitivity
PUS
Clinical uses of macrolides:

P - Pneumonia - atypicals (mycoplasma, chlamydia, legionella)
U - URI's (S. pneumo, S. pyogenes)
S - STD (chlamydia, gonorrhea)

MECH - bind 23S rRNA of 5OS --> block translocation

TOX - prolonged QT interval, GI, P-450 inhibition
TMP
Trimethoprim Treats Marrow Poorly (TMP)

TOX - Megaloblastic anemia, leukopenia, granulocytopenia

Alleviate with supplemental folinic acid

IND - UTI's, PCP (pneumocystis jiroveci), SS (salmonella, shigella), TMP-SMX for MRSA
FluoroquinolONES hurt attachment to your ______
BONES

Contraindicated in pregnant women and children d/t damage to cartilage.

Tendonitis and tendon rupture in adults

MECH - I DNA gyrase (topoisomerase II)
GET GAP on the Metro!
Use metronidazole for anaerobic infection below the diaphragm:

G - Giardia
E - Entamoeba histolytica (phagocytoses rbc's)
T - Trichomonas

G - Gardnerella vaginalis (Clue cells, inc pH)
A - Anaerobes (Bacteriodes, Clostridium)
P - H. Pylori (part of triple therapy, along with bismuth and amoxicillin (or tetracycline))

MECH - forms toxic metabolites in bacterial cell that damage DNA. Bactericidal, antiprotozoal

TOX - disulfuram-like rxn with alcohol
'MYXins MIX up membranes
Polymixin B, E

MECH - cationic, detergent-like molecules that bind cell membranes of bacteria and disrupt osmotic properties

IND - Pseudomonas, burns
ADMIN - topical, NOT oral
TOX -neuro, nephro (acute tubular necrosis)
RIPE for treatment
Tx for Mycobacterium tuberculosis:

R - Rifampin
I - Isoniazid
P - Pyrazinamide
E - Ethambutol

Prophylaxis - Isoniazid
INH-SPIRE
Anti-TB drugs

Streptomycin, Pyrazinamide, Isoniazid (INH), Rifampin, Ethambutol

Ethambutol TOX - optic neuropathy = red-green color blindness
INH
INH - Injures Neurons and Hepatocytes

MECH - decreases synthesis of mycolic acids
IND - Px and Tx for M. tuberculosis
TOX - neuro, hepato, drug-induced Lupus

*Use Pyridoxine (Vit B6) to prevent neurotox
4 R's
4 R's of Rifampin:

RNA polymerase inhibitor
Revs up P-450
Red/orange body fluid (tears, urine, vaginal)
Rapid resistance if used alone

IND - Tx - TB, leprosy; Px - meningococcal, H. influenza B
"A man to dine" takes of his coat
Amantadine

MECH - blocks viral penetration/uncoating (M2 protein);
Also causes release of dopamine

IND - influenza, Parkinson's

Rimantadine - does not cross BBB --> fewer CNS s/e
Never Ever Deliver nucleosides
Non-nucleoside reverse transcriptase inhibitors (NNRTI's):

N - Nevirapine
E - Efavirenz
D - Delavirdine

MECH - inhibit reverse transcriptase of HIV; prevent incorporation of DNA copy of viral genome into host DNA
SAFE Moms Take Really Good Care
Antimicrobials to avoid in pregnancy:

S - Sulfonamides -> kernicterus
A - AG's -> ototoxicity
F - Fluoroquinolones -> cartilage damage
E - Erythromycin

M - Metronidazole - mutagenesis
T - Tetracyclines -> discolored teeth, inhibition of bone growth
R - Ribavirin - teratogenic
G - Griseofulvin - teratogenic
C - Chloramphenicol - "gray baby"
REM sleep is like sex
increased pulse
penile/clitoral tumescence
decreases with age