Adam Shared Boards - 47 Picmonics

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)

Tinnitus

Vertigo

Ataxia

Nephrotoxicity especially with aminoglycosides

Dapsone

MOA: Similar to sulfonamides, but structurally distinct agent (Inhibit dihydropteroate synthase)

Leprosy (lepromatous and tuberculoid)

Pneumocystis jirovecii prophylaxis

Dermatitis herpetiformis (celiac disease)

Hemolysis if G6PD deficient

Fever, rash and methemogloinemia

Pigment changes

Daptomycin

MOA: Lipopeptide that disrupts cell membrane of gram ⊕ cocci; Bactericidal

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

Myopathy

Rhabdomyolysis

CPK elevation

Simeprevir

HCV protease inhibitor, preventing viral replication

Chronic HCV in combination with ledipasvir (NS5A inhibitor)

Do not use as monotherapy

Photosensitivity reactions

Rash

Menkes disease

X-linked recessive

Connective tissue disease

Impaired copper absorption and transport due to defective Menkes protein (ATP7A)

Decreased activity of lysyl oxidase (copper is a necessary cofactor); leads to defective collagen cross linking

Brittle, "Kinky" hair

Growth retardation

Hypotonia

May have silver hair

Sideroblastic anemia

Skin depigmentation

Neurologic dysfunction (eg, ataxia, peripheral neuropathy)

Osteoporosis

Scombroid

Spoiled dark-meat fish such as tuna, mahimahi, mackerel, and bonito

Bacterial histidine decarboxylase converts histidine to histamine

Frequently misdiagnosed as fish allergy

Mimics anaphylaxis

Acute burning sensation of mouth

Facial flushing

Erythema

Urticaria

Pruritis

May progress to bronchospasm, angioedema, hypotension

Peppery taste

Antihistamines. Albuterol and epinephrine if needed

Symptoms: throbbing headache, palpitations, abdominal cramps , diarrhea

These typically begin 10-30 minutes after ingesting the fish, and are self-limited

Patients sometimes describe a bitter taste, but this is not always present

Physical findings may include skin erythema, wheezing, tachycardia and hypotension

Hypophosphatemic Rickets

Vitamin D–resistant rickets

Phosphate wasting at proximal tubule

Rickets-like presentation

Can be secondary to Proximal renal tubular acidosis (type 2) which can be caused by Fanconi syndrome

Can be primary (X linked dominant)

Systemic 1° Carnitine Deficiency

Inherited defect in transport of LCFAs into the mitochondria leads to toxic accumulation

Weakness

Hypotonia

Hypoketotic

Hypoglycemia

Medium chain acyl-CoA dehydrogenase deficiency

Autosomal recessive disorder of fatty acid oxidation

Decreased ability to break down fatty acids into acetyl-CoA

Leads to accumulation of 8- to 10-carbon fatty acyl carnitines in the blood and hypoketotic hypoglycemia

May present in infancy or early childhood

Vomiting

Lethargy

Seizures

Coma

Liver dysfunction

Minor illness can lead to sudden death

Treat by avoiding fasting

Patient is asymptomatic until fasting occurs

IIa—Familial hypercholesterolemia

Autosomal dominant

Absent or defective LDL receptors

Increased LDL, cholesterol

Heterozygotes (1:500) have cholesterol ≈ 300mg/dL; homozygotes (very rare) have cholesterol ≈ 700+ mg/dL

Accelerated atherosclerosis (may have MI before age 20)

Tendon (Achilles) xanthomas

Corneal arcus

Defective ApoB-100

Xanthelasmas

Although other body parts have LDL recptors, 70% of LDL is cleared by the liver

In addition to cholesterol and LDL increase, there is a VLDL increase

IV—Hypertriglyceridemia

Autosomal dominant

Hepatic overproduction of VLDL

Increased VLDL, TG

Hypertriglyceridemia (> 1000 mg/dL) can cause acute pancreatitis because the binding capacity of albumin becomes overwhelmed

Coronary disease

ApoA-V

Ranolazine

Inhibits the late phase of sodium current thereby reducing diastolic wall tension and oxygen consumption

Indication: Angina refractory to other medical therapies

SE: Constipation, dizziness, headache, nausea, QT prolongation.

Does not affect heart rate or contractility

Laron syndrome (dwarfism)

Defective growth hormone receptors

Decreased linear growth

Increased GH, decreased IGF-1

Short height

Small head circumference

Characteristic facies with saddle nose and prominent forehead

Delayed skeletal maturation

Small genitalia

Glucagonoma

Tumor of pancreatic α cells

Overproduction of glucagon

Dermatitis (necrolytic migratory erythema), typically affects the groin mostly (but also face/extremities)

Elevated, painful, pruritic, coalesces to form large lesion with central clearing and bronze colored induration

Blistering and scaling

Diabetes (hyperglycemia)

Easily controlled with oral agents & diet, Usually does not require insulin

DVT

Declining weight

Depression

Anemia

Glossitis, cheilitis, blepharitis

MEN 1 Association

Gastrointestinal symptoms: Diarrhea, anorexia, abdominal pain, or occasional constipation

Neuropsychiatric (eg, ataxia, dementia, proximal muscle weakness)

Octreotide

Surgery

Hyperglycemia with elevated glucagon >500 pg/ml

Abdominal imaging (computed tomography or magnetic resonance imaging) to localize tumor &/or metastases

Normocytic, normochromic anemia due to likely anemia of chronic disease or glucagon directly affecting erythropoiesis

GLUCAGON LEVELS reach >500pg/mL NOT GLUCOSE the diabetes is mild usually

Most glucagonomas are malignant and have metasta sis, mainly in the liver, at the time of diagnosis

Some of its clinical manifestations are due to the secretion of other peptides, such as VIP, calcitonin, and GLP1

Somatostatinoma

Tumor of pancreatic δ cells

Overproduction of somatostatin

Decreased secretion of secretin, cholecystokinin, glucagon, insulin, gastrin

Diabetes/glucose intolerance

Steatorrhea

Gallstones because somatostatin decreases CCK secretion (decreased gallbladder contraction)

Can be hyperglycemia or hypoglycemic

Achlorhydria (due to inhibition of gastrin)

Inhibiting GI motility

Surgical resection

Somatostatin analogs (eg, octreotide) for symptom control

Salivary gland tumors

Most commonly in the parotid gland

Facial pain or paralysis suggests malignant involvement of CN VII

The facial nerve runs through the parotid gland

Benign mixed tumor which rarely transforms to a carcinoma (facial nerve invasion/pain)

Composed of chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptured intraoperatively

Mobile, painless, circumscribed

Most common salivary gland tumor

Most common malignant tumor

Mucinous and squamous components

Often involves the facial nerve

Alternative name: papillary cystadenoma lymphomatosum

Benign cystic tumor with germinal centers

Lymph node like stroma

Typically found in smokers. Bilateral in 10%; malignant in 10%.

Second most common

Almost always arises inthe parotid

Esophageal Carcinoma

Presents with progressive dysphagia (first solids, then liquids)

Weight loss

Pain; hematemesis

Poor prognosis; presents late

Lymph node spread: Upper 1/3 (cervical), Middle 1/3 (mediastinal and tracheobronchial), Lower 1/3 (celiac and gastric)

Can cause pseudoachalasia

Endoscopic evaluation can differentia te between achalasia and pseudoachalasia

Tumor metastasis (eg, mediastinal nodes) or local involvement may give a radiologic appearance similar to that seen with widened mediastinum

Definitive diagnosis of esophageal cancer requires esophageal endoscopy with biopsy

Young, low-risk patients with undetermined esophageal symptoms may start with barium esophagram

Surgery for definitive cure is advised for patients with limited-stage disease

Lower 1/3

Risk factors: Chronic GERD, Barrett esophagus, obesity, smoking, achalasia

More common in America

Arises from glandular tissue

Ulcerative/exophytic

Distal esophagus (from barretts)

Upper 2/3

Risk factors: Alcohol, hot liquids, caustic strictures, smoking, achalasia, esophageal web (Plummer-vinson), Injury (lye ingestion)

N-nitroso containing foods, betel nuts

More common worldwide

May have hoarse voice (Recurrent laryngeal) and cough (tracheal involvement)

Can cause GI bleed and iron deficiency anemia

Histology: Eosinophilic cytoplasm, keratin pearls, intercellular bridging

Plaque like thickening, may become ulcerated

Usually occurs in men over 50

Retrosternal discomfort/burning

U. In the USA its mostly due to alcohol and smoking

Caustic injestion is another cause

Arises anywhere in the esophagus

Fludrocortisone

Synthetic analog of aldosterone with little glucocorticoid effects

Mineralocorticoid replacement in 1° adrenal insufficiency

Similar to glucocorticoids

Edema

Exacerbation of heart failure

Hyperpigmentation

Cinacalcet

Sensitizes Ca2+-sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ causing a decrease in PTH

Indication: 1° or 2° (secondary in dialysis patients) hyperparathyroidism

Hypocalcemia

Secondary and tertiary hyperparathyroidism

2° hyperplasia due to decreased Ca2+ absorption and/or increased PO4 3−

Chronic renal disease (causes hypovitaminosis D decreased Ca2+ absorption)

Hypocalcemia, hyperphosphatemia

Increased ALP and PTH

Renal osteodystrophy

Refractory (autonomous) hyperparathyroidism

Result of chronic renal disease

Highly increased PTH, increased calcium

Requires surgery

Bone pain and an elevated bone-specific alkaline phosphatase (due to high bone turnover)

Adam Shared "Boards" - 47 Picmonics

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