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Lee Shared "Endo-1" - 95 Picmonics

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Endo-1

Glycogen Metabolism
Glycogenesis
Glucose to UDP-Glucose
Chain Elongation
UDP-Glucose to Glycogen
Glycogenin
Glycogen Synthase
Branching Enzyme
Glycogenolysis
Glycogen to Glucose
Glycogen Phosphorylase + Vitamin B6 Cofactor
Limit Dextrin
Debranching Enzyme
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4 mins
Glucagon (GlucaGen)
Mechanism
Increases Glucose
Indications
Hypoglycemic Emergency
Side Effects
Nausea and Vomiting
Considerations
Reconstitute Powder
Consume Oral Carbohydrates
50% Dextrose IV (If No Effect)
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2 mins
Gluconeogenesis
OVERVIEW
Produces Glucose from Non-Carbohydrate Substrates
Upregulated by Glucagon and Cortisol
PATHWAY
Pyruvate
Pyruvate Carboxylase
Oxaloacetate
Phosphoenolpyruvate (PEP) Carboxykinase
Phosphoenolpyruvate (PEP)
Fructose-1,6-bisphosphate
Fructose-1,6-bisphosphatase
Fructose-6-phosphate
Glucose-6-phosphate
Glucose 6-phosphatase
Glucose
Clinical Relevance
Von Gierke Disease
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4 mins
Cholesterol Synthesis
Pathway
Acetyl-CoA
Acetoacetyl-CoA
Cytosolic HMG-CoA Synthase
HMG-CoA
HMG-CoA Reductase
Mevalonate
Cholesterol
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2 mins
Familial Hypercholesterolemia (Type IIa Familial Dyslipidemia)
INHERITANCE
Autosomal Dominant
PATHOGENESIS
Defective or Absent LDL Receptors
Defective Apolipoprotein B-100 (ApoB-100)
Lab Findings
Increased LDL
Decreased HDL
Type IIb also has Increased VLDL
Symptoms/Findings
Accelerated Atherosclerosis
Achilles Tendon Xanthomas
Xanthelasma
Corneal Arcus
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4 mins
Hexose Monophosphate Shunt (Pentose Phosphate Pathway)
Oxidative Phase (Irreversible)
Glucose-6-Phosphate Dehydrogenase
Converts Glucose-6-Phosphate to Ribulose-5-Phosphate
Generates NADPH
Reduces Glutathione
Prevents Oxidative Damage
Non-Oxidative Phase (Reversible)
Ribulose-5-Phosphate to Ribose-5-Phosphate
Nucleotide Synthesis
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2 mins
Lipid Metabolism and Ketogenesis
Lipid Metabolism
Acetyl-CoA
Biotin Cofactor
Malonyl-CoA
Fatty Acids
Triglycerides
Glycerol
DHAP
Acetoacetyl-CoA
HMG-CoA
HMG-CoA Reductase
Mevalonate
Cholesterol
Ketogenesis
Acetoacetate
Beta-Hydroxybutyrate
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4 mins
Lipogenesis
Fatty Acid Synthesis
Acetyl-CoA
Citrate Shuttle to Cytoplasm
Acetyl-CoA Carboxylase
Biotin Cofactor
Malonyl-CoA
Fatty Acid Synthase
Triglyceride Synthesis
Glycerol
Glycerol-3-Phosphate Acyltransferase
Triglycerides
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2 mins
Lipolysis
Triglyceride Breakdown
Triglycerides
Hormone Sensitive Lipase
Glycerol
Fatty Acids
Fatty Acid Transport
Long-chain Fatty Acids
Carnitine Shuttle
Medium-chain and Short-chain Fatty Acids Diffuse Freely
Fatty Acid Breakdown
Beta Oxidation
Acetyl-CoA if Even Number of Carbon Atoms
Propionyl-CoA if Odd Number of Carbon Atoms
Propionyl-CoA Carboxylase
Biotin Cofactor
Methylmalonyl-CoA
Methylmalonyl-CoA Mutase
Vitamin B12 Cofactor
Succinyl-CoA
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5 mins
Ethanol Metabolism
Characteristics
Zero Order Elimination
Pathway
Ethanol
Alcohol Dehydrogenase
Produces NADH
Acetaldehyde
Acetaldehyde Dehydrogenase
Produces NADH
Acetate
Thiokinase
Acetyl-CoA
Drugs
Fomepizole
Disulfiram
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3 mins
Abetalipoproteinemia
Pathophysiology
Autosomal Recessive
Deficiency of Apolipoproteins B-48 and B-100
MTTP Gene Mutation
Clinical Features
Malabsorption
Steatorrhea
Failure to Thrive
Ataxia
Retinitis Pigmentosa
Spinocerebellar Degeneration
Diagnosis
Lipid-Laden Enterocytes
Acanthocytes
Decreased Cholesterol and LDL
Treatment
Vitamin E (Alpha-Tocopherol)
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4 mins
Dysbetalipoproteinemia (Type III Familial Dyslipidemia)
INHERITANCE
Autosomal Recessive
PATHOGENESIS
Defective Apolipoprotein E (Apo E)
Lab Findings
Increased Chylomicrons
Increased VLDL
Symptoms/Findings
Premature atherosclerosis
Tuberoeruptive xanthomas
Palmar xanthomas
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3 mins
Hyperchylomicronemia (Type I Familial Dyslipidemia)
INHERITANCE
Autosomal Recessive
PATHOGENESIS
Lipoprotein Lipase Deficiency (LPL)
Altered Apolipoprotein C-II (Apo C-II)
Lab Findings
Increased Chylomicrons
Increased Cholesterol
Increased Triglycerides
Symptoms/Findings
Pancreatitis
Hepatosplenomegaly
No Increased Risk for Atherosclerosis
Eruptive/Pruritic Xanthomas
Milky White Appearance of Blood When Drawn
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3 mins
PCSK9-Inhibitors
AVAILABLE DRUGS
Evolocumab
Alirocumab
MECHANISM OF ACTION
Monoclonal Antibodies
Bind the PCSK9 Enzyme
Decreased Degradation of LDL-receptors
Increased LDL Receptors on Hepatocytes
Reduction of LDL in Plasma
INDICATION
Second-line Therapy for Hypercholesterolemia
ADMINISTRATION
Subcutaneous Injection
SIDE EFFECTS
Skin Reaction at the Injection Site
Myalgia
Neurocognitive Impairment
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2 mins
Thyroid Gland
Characteristics
TSH Stimulates T3 and T4 Release
Metabolism Regulation
Blood Calcium Sensor
Calcitonin Release
Blood Calcium Decreases
Bone Building
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2 mins
11 Beta-Hydroxylase Deficiency
Pathophysiology
Decreased Cortisol
Decreased Aldosterone
Increased Sex Hormones
Increased 11 Deoxycorticosterone (11 DOC)
Signs and Symptoms
Hypertension
Masculinization
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1 min
17 Alpha Hydroxylase Deficiency
Decreased Cortisol
Decreased Sex Hormones
Increased Mineralocorticoids (DOC)
Hypertension
Hypokalemia
XY Externally Phenotypic Female
No Internal Reproductive Structures Due to Mullerian Inhibitory Factor
XX Externally Phenotypic Female
Sexual Infantilism
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2 mins
21 Hydroxylase Deficiency
Pathophysiology
Decreased Cortisol
Increased 17 Hydroxyprogesterone
Decreased Aldosterone
Signs and Symptoms
Hypotension
Increased Renin
Hyperkalemia
Female Pseudohermaphroditism
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2 mins
Acromegaly Assessment
Mechanism
Excess Growth Hormone (GH)
Signs and Symptoms
Protruding Jaw
Large Lips and Nose
Hearing Loss
Enlargement of Hands and Feet
Vision Changes and Headache
Joint Pain
Peripheral Neuropathy
Hyperglycemia
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2 mins
Addison's Disease
Mechanism
Chronic 1° Adrenal Insufficiency
Atrophy
Destruction
Symptoms
Deficiency In Cortisol And Aldosterone
Skin Hyperpigmentation
Increased POMC
Hypotension
Hyperkalemia
Acidosis
Addisonian Crisis
Diagnosis
ACTH (Cosyntropin) Stimulation Test
Treatment
Exogenous Cortisol
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2 mins

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Lee Shared Endo-1 - 95 Picmonics