Adam Shared "Learn - Mine" - 410 Picmonics

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Learn - Mine

Beta 3 Receptor
Increases Lipolysis
Skeletal muscle thermogenesis increase
Gs Protein Class
Increased CAMP
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Atypical Antipsychotic Names
These are all second generation antipsychotics
Varied effects on 5-HT2 (antagonism), dopamine, and α- and H1-receptors
Aripiprazole (Abilify) - D2 partial agonist
Asenapine, Clozapine, Quetiapine, Olanzapine
-pine associated with metabolic syndrome (Weight gain, Diabetes, Hyperlipidemia, tracking fasting glucose and lipid profile)
Clozapine and olanzapine carry the greatest risk of metabolic syndrome side effects
U. Olanzapine can be used for acute mania and anorexia
Olanzapine has affinity for muscarinic receptor
Most common side effects of olanzapine are sedation and weight gain
Most common side effects are metabolic syndrome and sedation (histamine)
Iloperidone, lurasidone, paliperidone, risperidone, ziprasidone
Ziprasidone most associated with QT prolongontion
Risperidone most associated with elevated prolactin
Ziprasidone, lurasidone and aripiprazole all have lower incidence of metabolic syndrome
Quitiepine is sedating and is often used in insomnia (or bipolar with insomnia); has an oral dissolving form
O. Risperidone has higher likelihood of EPS, all the drugs cause QT prolongtion
Olanzapine has a IM long acting as well as a rapid acting IM version for emergencies
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Hypo and Hypernatremia
Hypernatremia: Greater than 145, Irritability, stupor, coma, thirst
Hyponatremia: Less than 135, Nausea, malaise, stupor, coma, seizure
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Hyper and Hypophosphatemia
Hyperphosphatemia: Renal stones, metastatic calcifications, hypocalcemia
Hypophosphatemia: Bone loess, osteomalacia (adults), Rickets (Children)
Muscle weakness and paralysis
Rhabdomyolysis, paresthesia, respiratory failure
Can be due to alcoholism
Critically ill frequent ly develop intracellular phosphate defic iencies due to poor oral phosphate intake
Clinically silent until caloric supplementation with intravenous dextrose, a component of total parenteral nutrition (TPN)
Critically ill patients initiated on TPN --> monitor serum phosphate so that phosphate can be administered if a deficiency deve lops
Manifestation of refeeding syndrome
Can cause seizures, rhabdomyolysis, life-threaten ing cardiovascular complications (eg, arrhythmia, CHF)
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SIADH Causes and Treatment
Causes: Small Cell (Oat Cell) Carcinoma, CNS disorders/Trauma, Pulmonary disorders, cyclophosphamide
Treatment: Slowly correct sodium, Fluid Restriction, sodium tablets, IV hypertonic saline, diuretics, conivaptan, tolvaptan, demeclocycline
Tolvaptan And Conivaptan are ADH antagonists
CNS disturbance (eg, stroke, hemorrhage, trauma)
Medications (eg, carbamazepine, SSRls, NSAIDs)
Lung disease (eg, pneumonia )
Pain &/or nausea can be a cause
Treatment: Fluid restriction ± salt tablets
Hypertonic (3%) saline for severe hyponatrem ia
VAPTANS ARE NO LONGER EVER THE ANSWER
Unless there are neurologic symptoms arising from the hyponatremia , it should be corrected slowly with water restriction
Once water restriction is initiated , the plasma sodium concentration will slowly begin to normalize
An ideal rate of increase is 0.5 mEq/h
Patients must be simultaneously monitored for volume depletion as a sodium deficit may become apparent , requiring concomitant administration of salt
Demeclocycline (preferred) and lithium are indicated in patients with persistent severe hyponatremia
Valproic acid is another cause
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Adrenoleukodystrophy
X linked recessive (usually affects males)
Disrupts very-long-chain fatty acids metabolism
Impaired ability to add coenzyme A to fatty acids
Fatty acid build up in nervouse system (especially white matter of the brain), adrenals, testes
Progressive disease that can lead to long-term coma/death
Can cause adrenal gland crisis
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Multiple Sclerosis Interventions
Slow progression with disease modifying therapies: B-interferon, glatiramer, natalizumab
Acute flares: IV steroids
Neurogenic Bladder: Catheterization, muscarinic antagonists
Spasticity: Baclofen, GABA B agonist or tizanidine (alpha-2 adrenergic agonist)
Pain: Opioids
Acute attack and disabling --> high-dose IV glucocorticoids (eg, methylprednisolone), Plasma exchange in non responders
Chronic: can also use Fingolimod
Symptomatic: urine retention (Bethanechol), incontinence (Amitriptyline), neuropathic pain (gabapentin)
Disease-modifying (eg, beta-interferon, glatiramer) indicated for chronic maintenance in relapsing-remitting multiple sclerosis
Pregnancy: slightly increased C-section/assisted delivery (forceps) rates, treat exacerbations with IV corticosteroids
Lower disease activity during pregnancy and higher disease act ivity in the postpartum period, most MS drugs are safe during pregnancy
Teriflunomide and mitoxantrone are not safe during pregnancy
Fatigue
Sleep hygiene, regular exercise
Amantadine
Stimulants (eg, methylphenidate, modafinil)
Spasticity
Physical therapy & stretching
Massage therapy
Baclofen or tizanidine
Depression
SSRI/SNRI
Neuropathic pain
Gabapentin or duloxetine
Urge urinary incontinence
Timed voiding
Fluid restriction (<2 Uday)
Anticholinergic medication (eg, oxybutynin, tolterodine)
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Pseudogout
Causes: Hemochromatosis, idiopathic, hyperparathyroidism and joint trauma
Pseudo-gout or pseudo-arthritis
Crystals (from synovial fluid) are rhomboid and are weakly birefringent under polarized light (blue when parallel)
Colchicine: Both treatment and prophylaxis
Synovial fluid analysis will show an inflammatory effusion
In addition to synovial fluid analysis, X-ray can also be useful to diagnose and typically reveals chondrocalcinosis
Intra-articular glucocorticoids
Synovial fluid analysis will show an inflammatory effusion (15,000-30,000 cells/mm3)
Urate gout will have up to 50,000 cells/mm3 and septic arthritis will have >50,000 cells/mm3, + organisms on Gram stain
Hyperparathyroidism with hypercalcemia
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Beta Blocker Antidote and Side Effects
Antidote: Glucagon (causes increase in cAMP which causes calcium release --> cardiomyocite contraction), saline, atropine
Erectile dysfunction
Cardiovascular adverse effects (bradycardia, AV block, HF)
CNS adverse effects (seizures, sedation, sleep alterations)
Dyslipidemia (metoprolol)
Asthma/COPD exacerbations
Use with caution in cocaine users and pheochromocytoma due to risk of unopposed α-adrenergic receptor agonist activity
Except the nonselective α- and β-antagonists carvedilol and labetalol
Despite theoretical concern of masking hypoglycemia in diabetics, benefits likely outweigh risks; not contraindicated
Propranolol can exacerbate vasospasm in Prinzmetal angina
First steps in management are to secure the airway and give isotonic fluid boluses and intravenous (IV) atropine
In patients with refractory or profound hypotension , the next step is to administer IV glucagon
Not bold: Other therapies include IV calcium, vasopressors (epi/norepinephrine), high-dose insulin and glucose, IV lipid emulsion therapy
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Embryonal Carcinoma
Female
Malignant tumor
Large primitive cells
Aggressive with early metastasis
Stromal tumor
Male
All same as above female characteristics
May produce glands
Hemorrhagic mass with necrosis
Hematogenous spread
Chemotherapy may cause differentiation into another germ cell tumor
Possible increase in B-hCG or when its mixed increased AFP
Painful
Often a "mixed" with other tumors
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Prostatitis
Acute
Causes in young adult causes: Chlamydia Trachomatis, Neisseria Gonorrhoeae
Causes in older adults: E. Coli and Pseudomonas
Dysuria
Fever
Chills
Tender and boggy on digital rectal exam
Prostate secretions shows WBCs with bacteria
Chronic
Dysuria with pelvic pain or low back pain
Prostate secretions have WBCs but culture negative
Either bacterial or nonbacterial (eg, 2° to previous infection, nerve problems, chemical irritation)
Both
Possible slight PSA increase
U. (not sure acute or chronic) obstructive urinary symptoms,
purulent dyscharge, lower back/abdominal/pelvic pain, prostate may be boggy or nodular
Frequency; urgency; low back pain; warm/tender/enlarged prostate
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Sertoli/Leydig Tumor
Sertoli tumor is comprised of tubules and is usually silent
Leydig Males: produces androgen or estrogen causing precocious puberty in children and gynecomastia in adults; golden brown in color
Resemble sex cord stromal tissue of testicle
Reinke crystals may be seen histologically
Golden brown color; contains Reinke crystals (eosinophilic cytoplasmic inclusions)
Leydig/Sertoli in females: May cause hirsutism or virulization (androblastoma of the ovary), clitoromegally, deep voice, young women usually
Hollow or solid tubules lined by round Sertoli cells and surrounded by a fibrous stroma
Benign
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Rickettsia prowazekii and typhi
Rickettsia prowazekii
Rash travels outwards, spares the hands and feet
Commonly in POW camps and military camps
Caused by lice arthropod, defecates near feeding sites and the scratching that actually introduces it to the blood
Causes epidemic typhus; myalgia/arthralgia, pneumonia, encephalitis and coma
Rickettsia typhi
Causes endemic
Caused by flea
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Chlamydia pneumoniae and Chlamydia psittaci
Chlamydia Pneumoniae
Causes atypical pneumonia
Most common in young adults
Chlamydia psittaci
Causes atypical pneumonia
Transferred by birds, often parrots
Both
Treatment: Azithromycin (favored due to single dose), Doxycycline
Aerosol trasmission
Reactive arthritis (triad of arthritis, uveitis and urethritis
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Streptomycin
Aminoglycoside drug class
Interferes with 30S component of ribosome
Mycobacterium tuberculosis (2nd line)
IV only
Resistance in mycobacterium is via ribosomal alterations (as well as other aminoglycoside mechanisms of resistance)
Side Effects
Tinnitus
Vertigo
Ataxia
Nephrotoxicity especially with aminoglycosides
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Penicillinase-resistant penicillins
Dicloxacillin, nafcillin, oxacillin (several more with oxacillin at the end)
Same as penicillin. Narrow spectrum
Penicillinase resistant because bulky R group blocks access of β-lactamase to β-lactam ring
Clinical use: S aureus (non MRSA)
Hypersensitivity reactions, interstitial nephritis
Bactericidal
Methcillin not used anymore do to several side effects
Same side effects as penicillin
Resistance occurs via altered PBPs
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Oxazolidinones (Linezolid)
Inhibit protein synthesis by binding to 50S subunit and preventing formation of the initiation complex
Bacteriostatic
Indications: Gram ⊕ species including MRSA and VRE
Side effects
Bone marrow suppression (especially thrombocytopenia)
Peripheral neuropathy (optic most common but also glove and stocking peripheral nephropathy)
Serotonin syndrome due to MAOI activity
Sideroblastic anemia
Resistance
Point mutation of ribosomal RNA
Binds to the 23s portion
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Dapsone
MOA: Similar to sulfonamides, but structurally distinct agent (Inhibit dihydropteroate synthase)
Indications
Leprosy (lepromatous and tuberculoid)
Pneumocystis jirovecii prophylaxis
Dermatitis herpetiformis (celiac disease)
Side effects
Hemolysis if G6PD deficient
Fever, rash and methemogloinemia
Pigment changes
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Daptomycin
MOA: Lipopeptide that disrupts cell membrane of gram ⊕ cocci; Bactericidal
Indications
S aureus skin infections (especially MRSA), bacteremia, endocarditis, VRE
Not used for pneumonia (avidly binds to and is inactivated by surfactant)
Depolarizes cellular membrane by creating transmembrane channels
Side effects
Myopathy
Rhabdomyolysis
CPK elevation
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Pyrazinamide
Mechanism uncertain
Pyrazinamide is a prodrug that is converted to the active compound pyrazinoic acid
Works best at acidic pH (eg, in host phagolysosomes)
Indications: Mycobacterium tuberculosis
Side effects
Hyperuricemia (gout)
Hepatotoxicity (hepatitis)
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