Crack'em up by Marchiafava Bignami

ARE U HIGH!!!

An ex-heroin addict is maintained on Methadone, but he succumbs to temptation and buys an opioid on street. He takes it and rapidly goes into withdrawal. Which opioid did he take ???

• Meperidine
• Heroin
• Pentazocine
• Codeine
• Tramadol

Mnemonics

Corneal stromal dystrophies
"Marilyn Monroe Gets High in LA":
Macular-Mucopolysaccharide
Granular-Hyaline
Lattice-Amyloid

Cataracts: causes
CATARAct:Congenital
Aging
Toxicity (steroids, etc)
Accidents
Radiation
Abnormal metabolism (diabetes mellitus, Wilson's)

Red eye causes
GO SUCK:Glaucoma
Orbital disease
Scleritis
Uveitis
Conjunctivitis
Keratitis

Aortic stenosis characteristics SAD: Syncope
Angina
Dyspnoea

Murmurs: systolic types SAPS: Systolic-Aortic Pulmonary Stenosis
[Systolic murmurs include aortic and pulmonary stenosis.Similarly,it can also be mitral and tricusp regurgitation].
Murmurs: right vs. left loudness "RILE":
Right sided heart murmurs are louder on Inspiration.Left sided heart murmurs are louder on Expiration.
Murmurs: systolic vs. diastolic PASS: Pulmonic & Aortic Stenosis=Systolic.
PAID: Pulmonic & Aortic Insufficiency=Diastolic.

CAUSES OF ACUTE PANCREATITIS:
"GET SMASH'D"- Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune(PAN), Scorpion bites, Hyperlipidemia, Drugs(azathioprine, diuretics)

WBC Count: "Never Let Mom Eat Beans" and "60, 30, 6, 3, 1"
· Neutrophils 60%
· Lymphocytes 30%
· Monocytes 6%
· Eosinophils 3%
· Basophils 1:

Pain history checklist SOCRATES:
Site Onset Character Radiation Alleviating factors/Associated symptoms
Timing (duration, frequency) Exacerbating factors Severity/Symptoms

Physical exam for lumps - "6S and 3T go for CAMPFIRE":
Site, Size, Shape, Surface, Skin, ScarTenderness, Temperature, Transillumination ConsistencyAttachmentMobilityPulsationFluctuationIrreducibilityRegional lymph nodesEdge

Clubbing: causesCLUBBIN:
Cyanotic heart disease
Lung disease (hypoxia, lung cancer, bronchiectasis, cystic fibrosis)
UC/Crohn's disease
Biliary cirrhosis
Birth defect (congenital)
Infective endocarditis
Neoplasm (esp. Hodgkins)

Lupus signs and symptoms
SOAP BRAIN:
Serositis [pleuritis, pericarditis]
Oral ulcers
Arthritis
Photosensitivity
Blood [all are low - anemia, leukopenia, thrombocytopenia]
Renal [protein]
ANA
Immunologic [DS DNA, etc.]
Neurologic [psych, seizures]

GYNECOMASTIA:
Genetic Gender disorder (Klinefelter)
Young boy (pubertal)
*Neonate
*Estrogen
Cirrhosis/ Cimetidine/ Ca Channel blockers
Old age*
Marijuana
Alcoholism
Spironolactone
Tumors (Testicular & adrenal)
Isoniazid/ Inhibition of testosterone
Antineoplastics (Alkylating Agents)/ Antifungal(ketoconazole)
*physiologic

Oral contraceptives: side effects
CONTRACEPTIVES:Cholestatic jaundice
Oedema (corneal)
Nasal congestion
Thyroid dysfunction
Raised BP
Acne/ Alopecia/ Anaemia
Cerebrovascular disease
Elevated blood sugar
Porphyria/ Pigmentation/ Pancreatitis
Thromboembolism
Intracranial hypertension
Vomiting (progesterone only)
Erythema nodosum/ Extrapyramidal effects
Sensitivity to light

Different types of tongues

HUNTERS TONGUE/MOELLERS TONGUE------ PERNICIOUS ANAEMIA
BALD TONGUE OF SANDWITH-----------NIACIN DEFICIENCY(PELLAGRA)
MAGENTA OR BEEFY RED TONGUE-----------RIBOFLAVIN DEFICIENCY
STRAW BERRY(EARLY)AND RASBERRY(LATE)------SCARLET FEVER
SCROTAL TONGUE-----FISSUREE TONGUE
BLACK HAIRY TONGUE------PROLONGED ORAL USE OF ANTIBIOTICS.
CEREBRIFORM TONGUE-----A FEATURE OF PEMPHIGUS VEGETANS.

Why mosquitos cant transmit AIDS?

From: CDC National AIDS Clearinghouse (centre for disease control US)

From the onset of the HIV epidemic, there has been concern abouttransmission of the virus by biting and blood-suckinginsects. However, studies conducted by researchers at CDC andelsewhere have shown no evidence of HIV transmission throughinsects--even in areas where there are many cases of AIDS and largepopulations of insects such as mosquitoes. Lack of such outbreaks,despite intense efforts to detect them, supports the conclusion thatHIV is not transmitted by insects.
The results of experiments and observations of insect biting behaviorindiciate that when an insect bites a person, it does not inject itsown or a previous victim's blood into the new victim. Rather, itinjects saliva. Such diseases as yellow fever and malaria aretransmitted through the saliva of specific species ofmosquitoes. However, HIV lives for only a short time inside an insectand, unlike organisms that are transmitted via insect bites, HIV doesnot reproduce (and, therefore, cannot survive) in insects. Thus, evenif the virus enters a mosquito or another sucking or biting insect,the insect does not become infected and cannot transmit HIV to thenext human it feeds on or bites.
There is also no reason to fear that a biting or blood-sucking insect,such as a mosquito, could transmit HIV from one person to anotherthrough HIV-infected blood left on its mouth parts. Two factorscombine to make infection by this route extremely unlikely-- first,infected people do not have constant, high levels of HIV in theirbloodstreams and, second, insect mouth parts do not retain largeamounts of blood on their surfaces. Further, scientists who studyinsects have determined that biting insects normally do not travelfrom one person to the next immediately after ingesting blood.

Interesting Xray

chest xray of a 45 yr old woman with chronic cough and wt loss.

now jus see the obvious abnormality i.e the heart shadow, it is seen the right side.This can be either dextrocardia or the lab assisant has labelled L on the wrong side.so to come into conclusion jus look and the fundic gas shadow , even that appears to be o the right side.now carefully look and the lung fields.you can see a tram track shadows (encircled area.sorry couldn draw a better circle:). ) which are thickened bronchioles on side on view, and ring shadows on end on veiw, suggestive of emphysema.hence this might be a case of kartagener's syndrome.

Kartageners synrome is characterised by ciliary dysfunction which leads to:

1.bronchiectasis ( d/t defective ciliary clearance)

2.situs inversus (since visceral rotation during developement depends on proper ciliary motion)

3.recurrent attacks of sinusitis,otitis media,bronchitis,pneumonia etc( same as in 1)

4.infertility(defective sperm motility)

Chest Radiogrph

this is a normal chest radiograph.PA veiw (post-ant).normal structures seen in a plain radiograph are labelled above.

basic steps to be followed while interpreting a radiograph(

so that u dont miss any structures):

1.First check whether the radiograph is overpenetrated/underpenetrated/normal

2.positioning.( look at the trachea! it shld be at equidistant from either sternoclavicular joint)

3.look at the trachae,mediastenum,aortic knucle for any abnormalities

4.then the hilum and vascular markings

5.heart (size ,shape, any abnormalities,etc)

6.lung fields

7.diaphragm

8.fundic gas shadow

9.ribs and the shoulder girdle

10.soft tissue shadows arond the ribs

Hallmark findings

Albumino-Cytologic Dissociation
· Guillain-Barre (markedly increased protein in CSF with only modest increase in cell count)
Antiplatelet Antibodies
· idiopathic thrombocytopenic purpura
Arachnodactyly
· Marfan’s
Aschoff Bodies
· rheumatic fever
Auer Rods
· acute promyelocytic leukemia (AML type M3)
Autosplenectomy
· sickle cell anemia
Babinski
· UMN lesion
Basophilic Stippling of RBCs
· lead poisoning
Bence Jones Protein
· multiple myeloma free light chains (either kappa or lambda)
· Waldenstrom’s macroglobinemia
Birbeck Granules
· histiocytosis X (eosinophilic granuloma)
Blue Bloater
· Chronic Bronchitis
Boot-Shaped Heart
· Tetralogy of Fallot
Bouchard’s Nodes
· osteoarthritis (PIP)
Boutonniere’s Deformity
· rheumatoid arthritis
Brown Tumor
· hyperparathyroidism
Brushfield Spots
· Down’s
Call-Exner Bodies
· granulosa cell tumor
Cardiomegaly with Apical Atrophy
· Chagas’ Disease
Chancre
· 1 ° Syphilis
Chancroid
· Haemophilus ducreyi
Charcot Triad
· multiple sclerosis (nystagmus, intention tremor, scanning speech)
Charcot-Leyden Crystals
· bronchial asthma
Cheyne-Stokes Breathing
· cerebral lesion
Chocolate Cysts
· endometriosis
Chvostek’s Sign
· Hypocalcemia facial spasm in tetany
Clue Cells
· Gardnerella vaginitis
Codman’s Triangle
· osteosarcoma
Cold Agglutinins
· Mycoplasma pneumoniae · infectious mononucleosis
Condyloma Lata
· 2 ° Syphilis
Cotton Wool Spots
· HTN
Councilman Bodies
· dying hepatocytes
Crescents In Bowman’s Capsule
· rapidly progressive (crescentic glomerulonephritis)
Currant-Jelly Sputum
· Klebsiella
Curschmann’s Spirals
· bronchial asthma
Depigmentation Of Substantia Nigra
· Parkinson’s
Donovan Bodies
· granuloma inguinale (STD)
Eburnation
· osteoarthritis (polished, ivory-like appearance of bone)
Ectopia Lentis
· Marfan’s
Erythema Chronicum Migrans
· Lyme Disease
Fatty Liver
· Alcoholism
Ferruginous Bodies
· asbestosis
Ghon Focus / Complex
· Tuberculosis (1 ° & 2 ° , respectively)
Gower’s Maneuver
· Duchenne’s MD use of arms to stand
Heberden’s Nodes
· Osteoarthritis (DIP)
Heinz Bodies
· G6PDH Deficiency
Hemorrhagic Urticaria
· Henoch-Schonlein
Heterophil Antibodies
· infectious mononucleosis (EBV)
Hirano Bodies
· Alzheimer’s
Hypersegmented PMNs
· Megaloblastic anemia
Hypochromic Microcytic RBCs
· iron-deficiency anemia
Jarisch-Herxheimer Reaction
· Syphilis over-aggressive treatment of an asymptomatic pt. that causes symptoms 2° to rapid lysis
Joint Mice
· osteoarthritis (fractured osteophytes)
Kaussmaul Breathing
· acidosis
Keratin Pearls
· SCCA
Keyser-Fleischer Ring
· Wilson’s
Kimmelstiel-Wilson Nodules
· diabetic nephropathy
Koilocytes
· HPV
Koplik Spots
· measles
Lewy Bodies
· Parkinson’s (eosinophilic inclusions in damaged substantia nigra cells)
Lines of Zahn
· arterial thrombus
Lisch Nodules
· neurofibromatosis (von Recklinhausen’s disease)
Lumpy-Bumpy IF Glomeruli
· poststreptococcal glomerulonephritis
McBurney’s Sign
· appendicitis (McBurney’s Point is 2/3 of the way from the umbilicus to anterior superior iliac spine)
Michealis-Gutmann Bodies
· Malakoplakia
Monoclonal Antibody Spike
· multiple myeloma this is called the M protein (usually IgG or IgA) · MGUS
Myxedema
· hypothyroidism
Negri Bodies
· rabies
Neuritic Plaques
· Alzheimer’s
Neurofibrillary Tangles
· Alzheimer’s
Non-pitting Edema
· Myxedema · Anthrax Toxin
Notching of Ribs
· Coarctation of Aorta
Nutmeg Liver
· CHF
Painless Jaundice
· pancreatic CA (head)
Pannus
· rheumatoid arthritis
Pautrier’s Microabscesses
· mycosis fungoides (cutaneous T-cell lymphoma)
Philadelphia Chromosome
· CML · ALL
Pick Bodies
· Pick’s Disease
Pink Puffer
· Emphysema Centroacinar – smoking Panacinar - a1-antitrypsin deficiency
Podagra
· gout (MP joint of hallux)
Port-Wine Stain
· Hemangioma
Posterior/ Anterior Drawer Sign
· tearing of the PCL/ACL
Psammoma Bodies
· Papillary adenocarcinoma of the thyroid · Serous papillary cystadenocarcinoma of the ovary · Meningioma · Mesothelioma
Pseudohypertrophy
· Duchenne muscular dystrophy
Punched-Out Bone Lesions
· multiple myeloma
Rash on Palms & Soles
· 2° Syphilis · RMSF
Red Morning Urine
· paroxysmal nocturnal hemoglobinuria
Reed-Sternberg Cells
· Hodgkin’s Disease
Reid Index Increased
· chronic bronchitis
Reinke Crystals
· Leydig cell tumor
Rouleaux Formation
· multiple myeloma RBC’s stacked as poker chips
S3 Heart Sound
· L to R Shunt (VSD, PDA) · Mitral Regurg · LV Failure
S4 Heart Sound
· Pulmonary Stenosis · Pulmonary HTN
Schwartzman Reaction
· Neisseria meningitidis impressive rash with bugs
Simian Crease
· Down’s
Smith Antigen
· SLE (also anti-dsDNA)
Soap Bubble on X-Ray
· giant cell tumor of bone
Spike & Dome Glomeruli
· membranous glomerulonephritis
String Sign on X-ray
· Crohn’s bowel wall thickening
Target Cells
· Thalassemia
Tendinous Xanthomas
· Familial Hypercholesterolemia
Thyroidization of Kidney
· chronic pyelonephritis
Tophi
· gout
Tram-Track Glomeruli
· membranoproliferative glomerulonephritis
Trousseau’s Sign
· visceral ca, classically pancreatic (migratory thrombophlebitis) · hypocalcemia (carpal spasm)
These are two entirely different disease processes and different signs, but they unfortunately have the same name.
Virchow’s Node
· supraclavicular node enlargement by metastatic carcinoma of the stomach
Warthin-Finkeldey Giant Cells
· Measles
WBC Casts
· pyelonephritis
Wire Loop Glomeruli
· lupus nephropathy, type IV
­ AFP in amniotic fluid or mother’s serum
· Spina Bifida · Anencephaly
­ Uric Acid
· Gout · Lesch Nyhan · Myeloproliferative Disorders · Diuretics (Loop & Thiazides)

Wolf's amnesia

Wolf’s Amnesia is transient selective loss of memory during an exam that prevents one from remembering the eponymically-named diseases discovered by old, dead doctors.:-)