好累唷！

好累唷！好累唷！ 在“内科”已经开始的第一个星期里。。。几乎每天都从一大清早呆在医院到了傍晚晚餐的时间。。。回到房间，冲了凉，就都上床了。。。五天内，有三天是8点就入睡了。。。

是好？！是坏？！
好 - 感觉自己有点像“医学生”，有压力、有勤劳、有上进、有奋斗。。。为了9个星期后的大考！还有，早睡早起身体好！
坏 - 怎么了！我好像“一无所知”！都睡觉，没时间温习啦！烦呀！

最近这么累，发现原来和自己的捐血有关。。。
捐血前的我，可以不停的游上10圈。。。可是，那天，只游了2圈，我就“全身无力”、“头昏脑涨”、有着种种“缺血”的症状。。。（不可以怪捐血，因为我自己也不吃钙质，所以，真的需要至少一个星期才能康复。。。）
所以，这几天就不去游了。。。
“不进则退”的感觉超不爽！

是的，讲到捐血，有了15次的经验。。。
捐血是我在大学第一年开始的。。。（目标：每3个月捐一次。。。可是，有时碰到生病或考试，所以就拖延一些日子。一年都有2-3次啦！）
我的感觉是：“助人为快乐之本”，况且这是我“多余”的血。。。何乐而不为呢？！
一些朋友是因为怕血。。。
一些则是父母的反对。。。（太听话了吧？！都几岁了？！我妈也不肯，就不讲咯！哈！）
有些父母则说：“怎么了！我给你的补品、燕窝都给了别人了啦？！”
或是“自己都不够血，还给人？！”

你呢？！
若真的有“多余”的，何不来试试看捐血呢？！

我慌了。。。

一直以来都超有自信的我，终于慌了！！！
昨天和前天，我们study group开始讨论past year问题。。。
哇靠！怎么了。。。完全“一无所知”！
我的“知识”要不是已经忘得一干二净，则是“零零散散”的。。。
就连简单、基础的，都“挤”不出来呢。。。咳！

新的一年，新的开始。。。
非常希望自己争气点。。。
要不然，一不小心，可要多待下六个月。。。（如果3月的大考“肥佬”唑！）
怕怕！怕怕！

加油咯！

医学 vs 音乐

在医学院待了5年。。。
看到的现象，不是我们5年前可以预知的。。。


现在的我们，都是“行尸走肉”。。。巴不得可以回到5年前，从新考虑自己的抉择。。。
现在的我们，失去了当初天真、无知救济“有需要的人”的梦想。。。
现在的我们，渐渐的感受到“责任” 的重担。。。人命关天呀！
现在的我们，每天都是累、累、累！时间都把我们的青春给消磨了。。。
现在的我们，已经失去了冲劲。周末都宁愿把自己关在房间里，追戏、睡觉。。。感觉就像残废似的。。。但是，我们享受！
现在的我们，一听到有人想做医生，都会苦口婆心的打消他们的念头，除非你真的想“做医生”。。。赚钱的事，是骗人的。。。我们的付出，而金钱的付给，是低于女佣的薪金。。。再次声明 - 除非你真的想“做医生”！！！



音乐？！
我真的爱音乐！
可是，现实生活中，有谁能考它而生存了？！
昨天，第一次站在教会的台上，带领敬拜赞美，那足以让我非常的享受。。。回来时，还独自的享受在敬拜和音乐里边！感谢主！

非常谢谢我的母亲，是她送我去学钢琴的。。。
我还记得，小时候，因为自己想要有一架钢琴，可是家境经济真的不容许。。。
哪知，父母为了我的钢琴，辛苦的做了“会头”。。。感恩！感动！


每每在花钱的时候，都想到父母的节俭。。。
都觉得自己的不孝！
他们的含辛茹苦，可是自己却是如此的不争气！
快点让我赚钱吧！
好让我可以照顾他们！！
- 我爱你们！-

Medical Mnemonics part II

Arthritis: seronegative spondyloarthropathies
PEAR:
Psoriatic arthritis
Enteropathic arthritis (IBD)
Ankylosing sponylitis
Reiter's/ Reactive

Kawasaki disease: diagnostic criteria
CHILD:5 letters=5 days, >5 years old, 5 out 6 criteria for diagnosis:
Conjuctivitis (bilateral)
Hyperthermia (fever) >5 days
Idiopathic polymorphic rash
Lymphoadenopathy (cervical)
Dryness & redness of (i)lips & month (ii)palms & soles [2 separate criteria]

Thyroid carcinoma: features, prognosis of most popular
Most Popular is Papillary.·

Clinical features:
Papillae (branching)
Palpable lymph nodes
"Pupil" nuclei (Orphan Annie)
Psammoma bodies within lesion (often)·
Also, has a Positive Prognosis (10 year survival rate: 98%).

Urination: autonomic control
"When you pee, it's PISs":
Parasympathetic Inhibits Sympathetic.

Gram positive stain
Gram Positives
Stain Purple (violet-blue) because of
their thick Peptidoglycan layer

Hypercalcemia: symptoms of elevated serum levels
"Bones, Stones, Groans, Moans":
Bones: pain in bones
Stones: renal
Groans: pain
Psychic moans/ Psychological overtones: confused state

Wernicke-Korsakoff triad
Syndrome in alchoholics, who love to "drink CANs of beer":
Confusion
Ataxia
Nystagmus

SIADH: diagnostic sign
Syndrome of INAPPropriate Anti-Diuretic Hormone:
Increased Na (sodium)
PP (urine)·
SIADH is characterized by increased urinary sodium.

Felty's syndrome: components
SANTA:
Splenomegaly
Anaemia
Neutropenia
Thrombocytopenia
Arthritis (rheumatoid)

Conscious change: causes
AEIOU TIPS:
Alcohol
Encephalopathy
Infection
Opioid
Uremia
Trauma
Insulin
Psychosis
Syncope

Premature ejaculation: treatment
4 S's:
SSRIs [eg: fluoxitime]
Squeezing technique [glans pressure before climax]·
Sensate-focus excercises [relieves anxiety]
Stop and start method [5-6 rehearsals of stopping stimulation before climax]

Neuroleptic side effects onset
The rule of 4's:
Dystonia: 4 hours-4 days
Akathesia: 4 days-40 days
Extrapyramidal symptoms: 4 days-4 weeks
Tardive dyskinesia: 4 months (greater than)·

Note that tardive is obviously the latest one to happen (tardive=tardy/late).·
Note that the first letters of these four classic symptoms spell "DATE", and this mnemonic is the dates when they occur.

Pulmonary fibrosis: differential of both upper and lower lobes
BREAST SCAR:·
Upper lobe:
Beryliosis
Radiation
Extrinsic allergic alveolitis
Ankylosing spondylitis
Sarcoidosis
TB·

Lower lobe:
Systemic sclerosis
Cryptogenic fibrosing alveolitis
Asbestosis
Radiation


Strep throat score / Issac Criteria
NO FACE:
NO cough: no cough is +1
Fever: has fever is +1
Age: less than 5 years is -1, 15-45 years is 0, greater than 45 years is +1
Cervical nodes: cervical nodes palpable is +1
Exudate: tonsillar exudate is +1·

Scoring interpretation:
Score 0-1: no strep throat.
Score 1-3: possible strep throat, do a swab test.
Score 4-5: strep throat is likely, so treat empirically.

Haematology: key numbers
3 and 4 are key in in haematology:
1.34 cm3 of oxygen is carried by a gram of hemoglobin.
There's 3.4mg of iron in each gram of hemoglobin.
There's an average of 3.4 lobes per neutrophil.
There's 34mg bilirubin from each gram of hemoglobin.

Thigh: innervation by compartment
"MAP OF Sciatic":
Medial compartment: Obturator
Anterior compartment: Femoral
Posterior compartment: Sciatic·
So all the thigh muscles in that compartment get innervated by that nerve.

Beck's triad (cardiac tamponade)
3 D's:
Distant heart sounds
Distended jugular veins
Decreased arterial pressure

Paget's disease of bone: signs and symptoms
Four L's:
Larger hat size
Loss of hearing: due to compression of nerve
Leontiasis ossea (lion-like face)
Light-headed (Paget's steal)

Kidney hilums at transpyloric plane [L1]
L-1 goes through hilum of only 1 kidney, and it's the Left one

Down syndrome pathology
DOWN:
Decreased alpha-fetoprotein and unconjugated estriol (maternal)
One extra chromosome twenty-one
Women of advanced age
Nondisjunction during maternal meiosis

T2 vs. T1 MRI scan
"WW 2" (World War II):·
Water is White in a T2 scan.·
Conversely, a T1 scan shows fat as being whiter.

Malignant melanoma: 3 sites with poor prognosis
BANS:
Back of Arm
Neck
Scalp

Alpha-fetoprotein: some major causes for increased maternal serum AFP during pregnancy
TOLD:
Testicular tumours
Obituary (fetal death)
Liver: hepatomas
Defects (neural tube defects)

Stroke: young patient's likely causes
7 C's:
Cocaine
Consanguinity [familial such as neurofibromatosis and von Hippel-Lindau]
Cancer
Cardiogenic embol
hyperCoagulation
CNS infection [eg: HIV conditions]
Congenital arterial lesion

Congenital talipes equinovarus (CTEV, clubfoot): major physical findings
CAVE:
Cavus
Adduction
Varus
Equinus

Hirsutism vs. virilism
Hirsutism: Hair on body like a male.
Virilism: Voice and rest of secondary sexual characteristics like a male.

Wiskott-Aldrich syndrome: symptom triad
WASTER:Wiskott Aldrich Syndrome is:
Thrombocytopenia
Eczema
Recurrent staphlococcal infections

Pheochromocytoma: common symptoms
5 P's:
Paroxysmal rise in BP
Palpitations
Perspiration
Pain in abdomen
PMV in urine

Colon carcinoma: aeitiology
CRAPS:
Chronic ulcerative colitis
Ratio of animal fat:fibre diet
Adenomatous polyps
Familial Polyposis
Strong family history of colon cancer.


Source: http://www.medicalmnemonics.com/

Medical Mnemonics part I

MI: sequence of elevated enzymes after MI
"Time to CALL 911":· (From first to appear to last:)
Troponin
CK-MB
AST
LDH1

Rashes: time of appearance after fever onset
"Really Sick Children Must Take No Exercise":·
(Number of days after fever onset that a rash will appear:)
1 Day: Rubella
2 Days: Scarlet fever/ Smallpox
3 Days: Chickenpox
4 Days: Measles (and see the Koplik spots one day prior to rash)
5 Days: Typhus & rickettsia (this is variable)
6 Days: Nothing
7 Days: Enteric fever (salmonella)

Gout: major features
GOUT:
Great toe
One joint (75% monoarticular)
Uric acid increased (hence urolithiasis)
Tophi

Gout: factors that can precipitate an attack of acute gouty arthritis
DARK:

• Diuretics
• Alcohol
• Renal disease
• Kicked (trauma)·
• And, the attack occurs most often at night [thus "dark"].

Hepatitis: transmission routes
"Vowels are bowels":

Hepatitis A and E transmitted by fecal-oral route.

Rheumatic fever: Revised Jones criteria
JONES PEACE:·
Major criteria:

• Joints: migratoryO (heart shaped)
• Carditis: new onset murmur
• Nodules, subcutaneous: extensor surfaces
• Erythema marginatum
• Sydenham's chorea·

Minor criteria:

• PR interval, prolonged
• ESR elevated
• Arthralgias
• CRP elevated
• Elevated temperature (fever)·

Need 2 major or 1 major and 2 minor criteria, plus evidence of recent GAS infection (throat cx, rapid antigen test, or rising strep antibody titer).


Pterygoid muscles: function of lateral vs. medial
"Look at how your jaw ends up when saying first syllable of 'Lateral' or 'Medial' ":
"La": your jaw is now open, so Lateral opens mouth.
"Me": your jaw is still closed, so medial closes the mandible.

Hypersensitivity reactions: Gell and Goombs nomenclature
ACID· (From I to IV:)
Anaphylactic type: type I
Cytotoxic type: type II
Immune complex disease: type III
Delayed hypersensitivity (cell mediated): type IV

APKD: signs, complications, accelerators
11 B's:·
Signs:

• Bloody urine
• Bilateral pain [vs. stones, which are usually unilateral pain]
• Blood pressure up
• Bigger kidneys
• Bumps palpable·

Complications:

• Berry aneurysm
• Biliary cysts
• Bicuspid valve [prolapse and other problems]·

Accelerators:

• Boys
• Blacks
• Blood pressure high

Hemoglobin binding curve: causes of shift to right
"CADET, face right!":
CO2
Acid
2,3-DPG (aka 2,3 BPG)
Exercise
Temperature

Epidermis layers
"Come, Let's Get Sun Burned":· (From superficial to deep:)
Corneum
Lucidum
Granulosum
Spinosum
Basale [Germinativum]·
Alternatively:
"Can Lori Get Some Gas?"·
"Can Little Girls Speak German?"·
"Can Larry Get Some Beer?"

External carotid artery branches
"Some Aggressive Lovers Find Odd Positions More Stimulating":
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occiptal
Posterior auricular
Maxillary
Superficial temporal

Ventricular tachycardia: treatment
LAMB:
Lidocaine
Amiodarone
Mexiltene/ Magnesium
Beta-blocker

Glycogen storage: names of types I through VI
"Viagra Pills Cause A Major Hardon":
Von Gierke's
Pompe's
Cori's
Anderson's
McArdle's
Her's

Suicide risk factors
SAD PERSONS scale:
Sex: male
Age: young, elderly
Depression

Previous suicide attempts
Ethanol and other drugs
Reality testing/ Rational thought (loss of)
Social support lacking
Organized suicide plan
No spouse
Sickness/ Stated future intent


Weights of children with age
Newborn 3 kg
6 mos 6 kg (2x birth wt at 6 mos)
1 yr 10 kg (3x birth wt at 1 yr)
3 yrs 15 kg (odd yrs, add 5 kg until 11 yrs)
5 yrs 20 kg
7 yrs 25 kg
9 yrs 30 kg
11 yrs 35 kg (add 10 kg thereafter)
13 yrs 45 kg
15 yrs 55 kg
17 yrs 65 kg

Head circumference with age
· Remember 3, 9, and multiples of 5:
Newborn 35 cm
3 mos 40 cm
9 mos 45 cm
3 yrs 50 cm
9 yrs 55 cm



Source: http://www.medicalmnemonics.com