Nice mnemonic for the phases of puberty / sexual development in girls:

Boobs, pubes, grow and flow. (In medical lingo that’s thelarche, adrenarche, growth spurt, and menarche.)

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So I got pimped mercilously by my attending two days ago, while I was sick, feeling like crap, and had only seen my patient for like 20 minutes. So it never happens to you, I present the quick’n’dirty acid-base disorder step-by-step guide:

1. Get a blood gas. Put it in ice, send it to the lab.
2. Look at pH: Less than 7.4? Acidosis. Greater than 7.4? Alkalosis.
3. Look at pCO ₂ and bicarb. Do they move in the same direction as the pH, or the opposite direction? (Nl pCO ₂ = 40, nl bicarb = 24.) If they move in the sa ME direction, it’s primary ME tabolic. If they move in a diffe RE nt direction, it’s primary RE spiratory.
4. Is the non-primary system compenstating appropriately? (Calculate that with those annoying equations I can never remember.)
5. Is there an anion gap? (Na – Cl – bicarb > 12) If no, you’re done.
6. If yes, take the anion gap – 12. Add that to the bicarb level. If it’s greater than 26, you’ve got a metabolic alkalosis as well. If it’s less than 22, you’ve got a non-anion gap metabolic acidosis, too. Classic pimping: You can have 3 disorders co-existing, but not 4. (Your lungs can either be making respiratory acidosis or alkalosis, not both.)

And on to the mnemonics for the causes:

Anion Gap Metabolic Acidosis: MUDPILERS

• Methanol
• Uremia
• DKA/Alcoholic KA
• Paraldehyde
• Isoniazid
• Lactic Acidosis
• Etoh/Ethylene Glycol
• Rhabdo/Renal Failure
• Salicylates

Non-Anion Gap Acidosis: HARDUPS

• Hyperalimentation
• Acetazolamide
• Renal Tubular Acidosis
• Diarrhea
• Uretero-Pelvic Shunt
• Post-Hypocapnia
• Spironolactone

Acute Respiratory Acidosis (Chronic Respiratory Acidosis = COPD/restrictive lung dz): any hypoventilation state

• CNS Depression (drugs/CVA)
• Airway Obstruction
• Pneumonia
• Pulmonary Edema
• Hemo/Pneumothorax
• Myopathy

Metabolic Alkalosis: CLEVER PD

• Contraction
• Licorice*
• Endo: Conn’s/Cushing’s/Bartter’s)*
• Vomiting
• Excess Alkali*
• Refeeding Alkalosis*
• Post-hypercapnia
• Diuretics

* = Associated with High Urine Cl levels

Respiratory Alkalosis: CHAMPS (think speed up breathing)

• CNS disease
• Hypoxia
• Anxiety
• Mech Ventilators
• Progesterone
• Salicylates/Sepsis

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A quick jaunt through the little catch phrases that are my life right now (thank you, First Aid). And hey, you might learn a thing or two:

• Bladder Cancer (Transitional Cell Carcinoma) in your Pee SAC: caused by Phenacetin, Smoking, Schistosomiasis (thanks Kat), Aniline Dyes, and Cyclophosphamide. Pee Sac is just such a great way to refer to your bladder. Also reminds me of Forat from Ali G referring to the scrotum as the “testes satchel.”
• Citric Acid Cycle. Cindy Is Kinky So She Fornicates More Often. Citrate, Isocitrate, alphaKetoglutarate, SuccinylCoA, Succinate, Fumarate, Malate, Oxaloacetate. Replace “Fornicates” with something else for added fun.
• Urea Cycle. Ordinarily, Careless Crappers Are Also Frivolous About Urination. Ornithine, Carbamoyl phosphate, Citrulline, Aspartate, Arginosuccinate, Fumarate, Arginine, Urea.
• Burkitt’s Lymphoma. BurC-Myc’s. (C-myc oncogene, 8:14 translocation.)
• Complications of Lung Cancer: SPHERE. Superior Vena Cava Syndrome, Pancoast’s Tumor, Horner’s Syndrome, Endocrine/paraneoplastic, Recurrent Laryngeal Nerve Palsy, Effusions (pleural, pulmonary).
• SLE-like syndrome caused by drugs: It’s not HIPP to have lupus. anti-Histone antibody, Hydralazine (vasodilator), INH (TB), Procainamide (Ia anti-arrhythmic), Phenytoin (anti-epileptic).
• Hypercalcemia is a MISHAP! Malignancy, Intox of Vitamin D, Sarcoidosis, Hyperparathyroidism, Alkali Syndrome, Paget’s Disease of Bone!
• Dilated/Congestive Cardiomyopathy Causes: ABCD. Alcohol, wet Beriberi, Coxsackie, Cocaine, Chagas’s, Doxorubicin.
• INH: Injures neurons and hepatocytes. Prevent neuron damage by giving Vitamin B6.
• Vincristine and vinblastine: prevent formation of microtubules, anti-cancer drugs. VinCristine Crushes Neurons, and VinBlastine Blasts Bone Marrow.
• Causes of Fibronous Pericarditis: UReMIa. Uremia, Rheumatic Fever, Myocardial Infarction.
• Kawasaki’s Disease, a vasculitis: Kids, Koronaries, Konjunctivitis, Krusty Lips, Strawberry Tongue.
• Buerger’s Disease, a vasculitis: Try the world RENOWNED Smokey Burger! (Buerger’s has Reynaud’s phenomenon, plus gangrene, in smokers.)
• Post-Strep Glomerulonephritis: Sub-Epi (STREPI) humps.

And hundreds more where that came from. But I’ll stop boring you now.

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The last few weeks of school were literally a flurry of multi-colored pens on paper for me. Writing notes, then writing notes about my notes, then organizing my information differently, and taking notes on those notes. And I must say, I noticed a change in my writing style. I could easily get through a page of notes conveying facts and concepts without using verbs, and shortening nouns into abbreviations, acronyms, or just pulling out all the vowels from the word.

bq(quote). HCTZ -> ↑ Ca ²⁺ ↓ Na ⁺ H ⁺ K ⁺ @ distal CT; Tx: HTN; Tox: HyperGLUC

actually means

bq(quote). Hydrochlorothiazide increases calcium blood levels, but decreases sodium, hydrogen (acid), and potassium levels. It acts at the distal convoluted tubule, and it’s used to treat hypertension. It has a number of toxicities/side effects: hyperglycemia, hyperlipidemia, hyperuricemia, and hypercalcemia.

I can go on for pages and pages, with arrows, letters with circles around them. And anytime you see an “x,” it’s usually just an abbreviation for some word we have to write all the time, and prefer not to:

* Dx = diagnosis
* Rx = prescription
* Tx = treatment
* Cx = complications
* Chx = characterized by
* Sx = symptoms
* SFx = Side effects
* Bx = biopsy

And on, and on. I’m sure I’ve just barely touched the surface.

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By George, I’ve done it. I’ve discovered the mystery behind the notoriously bad handwriting of the physician. It’s medical school that’s to blame. You could take a calligrapher extrordinaire, or my friend Yen Pham from elementary school, who had the best handwriting I’ve ever seen in my life, put either one in medical school, and their legibility would drop to that of a three year old. A three year-old on 4 cups of coffee. And 2 bags of M&M’s. Writing in a dune buggy going off-roading.

Here’s how the game will be played out for the next 3 quarters, according to my Miss Cleo-like predictions: I get to memorize physiology, which can be somewhat over-analytical, but at least has some logic to it, and makes sense. As for pharmacology and pathology, however, it’s all rote memorization. Some of the drug names have common endings, but most are woefully lacking in any logical naming scheme. This has led me to try using pitiful, ridiculously inane mnemonic devices, which are almost as hard to remember as the drugs themselves. (Example: Prop Tim’s nads [and] carve [him a] label pin! That would be beta blockers. Sigh. I’m trying here. Seriously.) Pathology is only slightly better, but naming diseases after people is about as terrible an idea as you can get.

But this tangent does have a point. Because this stuff is so hard to memorize, a lot of my classmates and I have to write everything out to get it to stick in our heads. And then write it out again. And then write it out another time from memory. And again. Ad nauseum. And since we’re just writing it out for ourselves, and sometimes we don’t ever look at the sheet of paper again, our handwriting gets sloppy. And our hands get tired. And then the vicious cycle continues, and before you know it, your handwriting’s gone to crap. (Personal note: I’ve always had bad handwriting, partially because I’m a lefty. I proudly received grades of “S-“–unsatisfactory–when I was in elementary school, and never got any better. Nobody’s perfect, right? You have to be bad at something. Mine just happened to be handwriting and gym.)

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Stanford Anatomists Like Fettucini, Others Prefer Swedish Meatballs.

Superior Thyroid, Ascending Pharyngeal, Lingual, Facial, Occipital, Posterior Auricular, Superficial Temporal, Maxillary.

(I have several dirtier versions in mind, but Google SafeSearch is going to start blocking me if I continue. And I got an email from an 11th-grade teacher that said she was going to share the Self-Service essay with her class, so I’ll try to keep it clean, in case they find me.)

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To Zanzabar by Motor Car!

From top to bottom of the face:

Temporal, Zygomatic, Buccal, Mandibular, Cervical

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Old Boys Fancy Labias
(Obturator nerve is split by adductor brevis; femoral artery is split by adductor longus.)

Could’ve been “old boys fart lots,” but I find that generally the more sexual, the more likely I am to remember it. Go figure.

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Randy Travis Drinks Cold Beers

(Roots, Trunks, Divisions, Cords, Branches, from medial to lateral)

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Nobody Likes My Educational Background!

(Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils)

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