USMLE Mnemonics: Biochem

Finished biochem review!  If there’s one subject it’d be good to have mnemonics in, this one would be it.  I’m ignoring the standards (“Cut the PYE” “PURe As Gold”, etc) to bring you the ones buried deep in the depths of the internet (which I only discovered through a pretty epic amount of procrastination disguised as mindless scrolling.)

Kompetitive enzymes inKrease the Km.  Therefore it’s the non-competitive ones that increase Vmax while keeping Km the same.

“Guardian Angels are Pure, with 2 Wings” – Purines (G and A) have 2 rings.  (Alternatively, I’ve also heard “Pyrimidines are CUT from purines” to remind you that pyrimidines are smaller.)

Glycogen Storage Diseases:  ABCD – Anderson’s = Branching enzyme defect, Cori’s = Debranching enzyme defect.

Pompe’s Disease:  The POLYSE Arrest 1 of the 4 Girls.  (Police = POmpe’s + LYSosomal Alpha-1,4 Glucosidase)

Arginine as the precursor to nitrous oxide:  Before the dentist administers nitrous oxide to numb your teeth, you shout “ARG!”

Electron Transport Chain:  RotenONE is a specific inhibitor of Complex ONE

“In the Phasted State, Phosphorylate!” helps you remember which hormone tends to phosphorylate (glucagon).  Nice, since a little bit of deductive thinking then gives you a major clue to the 2nd-messenger cascade of every enzyme that could possibly be tested.

And how about you- any other good mnemonics or memorization tricks?

DIT’s Solid Anatomy Videos

Doctors In Training gave me free Solid Anatomy videos to view and asked me to give them input on it.  I agreed because 1) I love online medical education, 2) I hate the way med school anatomy is traditionally taught, and 3) I was briefly living in a fantasy universe where I’d actually have time to write the review in a reasonably timely fashion.  Whoops.  One month later…

It’s hard to review new resources without comparing them to what currently exists.  So let’s start with:

Traditional Resources for Anatomy: The Options

1.  Anatomy textbook.  It’s always the same exact anatomy textbook. All I can say about this textbook is that I really, really hated it the first 3 times it was assigned (college anatomy classes in ascending difficulty), but by the time med school rolled around, I actually thought it was pretty awesome.

Don’t know if that anecdote says more about the baseline level of anatomy knowledge required to really “get it”, or something unflattering about me personally.  Either way.

2.  Anatomy atlas.  An M1 opening their Netter’s Atlas is like Bilbo Baggins unfolding the map to The Lone Mountain and thinking, “Hey, okay, that doesn’t look too bad!”

Sure, it tells you what you need to know, and the art is so damned pretty it defies description, but it doesn’t exactly do your job for you, and some of those cute mountains might just be a little bigger than they seem on paper, bro.

5.  Your med school’s actual Gross Anatomy course.  Haha, no, just kidding. Slides like the one below contribute more to your systolic blood pressure than they do to your knowledge base:

dissection of plantar foot


So my point is, there is room for improvement here.  Medical school anatomy has the unfortunate position of being taught by doctorates at a doctorate level (read: 160 slides in 55 minutes), when what most of us really need is to have a 3rd year surgical resident stand up there and say “I hated anatomy, I was awful at it, but by the time I finally learned it here’s what I realized I was getting hung up on.”

So now, after watching DIT Solid Anatomy videos on The Eye and The Orbit, here’s


What DIT Solid Anatomy Brings to the Table:

1.  Focus on The Basics.  This is not the beautiful map of Middle-Earth depicting The Shire and The Lone Mountain and Mordor all the possible obstacles and quaintly named cave trolls in-between and maybe some cool historical side-trips with historical relevance.  This is Google Maps.  This is how to get where you want to go.

Depending on who you are, this is either a pro or a con.  If you’re a 1st year medical student, this is very much a pro – you need a lecture like DIT’s to give you the background info necessary to make your medical school’s anatomy lecture make sense.  It gives you context and a way to understand why the important parts are important.

For example, on your med school’s vocab list of fifty bajillion structures, why would you focus on any one of them above the others?  Where’s the context?

DIT correctly points out that you want to pay attention to the orbital septum because it marks the anatomic difference between pre-orbital cellulitis and orbital cellulitis, which – much like the difference between a paper cut and full-on nuclear war – is pretty damned testable.  It gives context to what you need to learn.

2.  Humor.  Dr. John Phelan, the guest instructor for the videos I watched, is possibly the funniest surgeon on the planet.  (Actually, wait, I have no idea if he’s really a surgeon.  I might have made that up.  But let’s say he is.  Let’s keep the dream alive.)

3.  Memory devices that stick.  Mnemonics are over-played in anatomy, but that doesn’t mean that all memory tricks are useless.  Sometimes wry comments stick in your head far longer than you’d expect.  After all, how do you forget cheesy jokes about ocular anatomy?  How do you forget snorting so loud and in such an unlady-like fashion that your roommate starts laughing at you through the wall?

Not easily.  And not on test day.

And certainly not on Step 2 CK, where I may or may not have correctly answered a tricky orbital anatomy question based solely on a wry comment from a video I’d watched almost a full three weeks prior.

Each lecture is $6 for online access and comes with a pdf for you to fill out as you watch it.  I’d definitely recommend buying 1 or 2 to see how they work with your learning style.

USMLE Step 2: Summarizing Stuff That’s Made More Complicated Than Necessary

1.  Antiarrhythmic Drugs:  Atropine speeds shit up. Adenosine slows it down. Amiodarone fixes anything, but kills your lungs. Everything else is 6th line.

2.  Antipsychotic Drugs:  All that’s worth knowing about the 2nd gens are their major side-effects, which luckily mirror their names: Olanzapine causes weight gain cause “o” is the fattest letter. Aripiprazole and Ziprasidone sound zippy and thin, and are both weight-neutral.  (Ziprasidone is, in fact, so zippy that it can cause arrhythmias).  And finally, Quetiapine sounds like “quiet”, which is appropriate because it has the quietest side-effect profile (the least risk of extrapyradimal S/Es or increased prolactin).

3:  Sensitivity of a test vs its Positive Predictive Value:  Tricky because they seem so similar, so the temptation is to think of them as the same exact thing.  Textbooks do a crappy job of explaining the difference, I think, so here’s my attempt at it:

sensitivity vs PPV

Say your friend makes an instant swab test for The Bubonic Plague.  The test correctly catches all but 1% of her PI’s Yersinia Pestis Orientalis samples at the expense of also catching 5% of the perfectly healthy controls- so her screening test is 99% sensitive and 95% specific.  You are impressed.

She swabs your cheek with it to while she’s explaining the test to you.  If the test then gives a positive result, how worried about imminent death would you really be?

Answer: you shouldn’t be worried at all, because The Bubonic Plague is so rare that the odds of you being one of the 5% false positives vastly eclipses the chance you are the index case of a modern pandemic.

So despite being an extremely sensitive test, it has a low PPV… in the modern population.  The key point is that if you were a medieval European peasant getting that same swab and testing positive, you’d correctly be far, far more worried.  The Positive Predictive Value of the exact same test would be higher in the 14th century.

And that’s the point: sensitivity & specificity depend only on the test, whereas PPV and NPV also depend on the prevalence of the disease of the population being screened.

Potassium Limericks

Based on the premise that it’s easier to memorize rhymes than kidneys.

In hypOkalemia, medics
should first suspect loop diuretics,
steroids used thoughtlessly,
Magnesium paucity,
Or any cause hyperemetic.

Total parental nutrition
or maybe C.A. inhibition!
Villous adenomas
or DKA comas
Or hyper-adrenal conditions.

For excess potassium terror,
It’s renal OR adrenal failure
Succinylcholine, most types of gangrene,
or a digoxin OD (though that’s rarer).

Or SHH syndrome which can be treated
with fludrocortisone taken as needed!
In long-term; kayexalate
But now, Ca+ gluconate
And furosemide here can’t be beat..ed.

(… okay, I know – but hey, I tried.  HUMANITIES IN MEDICINE, folks.)
*drops mic, spreads arms wide, walks out backwards*

Memorizing Cyp450 Inducers & Inhibitors

One of my favorite new apps on my Android phone is made by Pendragon Entertainment: USMLE Pharmacology.  Definitely recommend it – while I was setting it up yesterday, it asked me about cytochrome p450 inhibitors and inducers so many times that I accidentally learned them.

(I know, right?  Technology!)

It seems like the first step was being able to recognize that a drug is a cytochrome p450 something.  The commonly tested ones, at least on that app, were these:  Erythromycin, quinidine, rifampin, isoniazid, griseofulvin, cimetidine, carbamazepine, phenytoin, and phenobarbital.

And that’s basically the hard part, because I realized the names themselves are simply divided into “quick” names (inducers) and “slow” names (inhibitors).

Of course, you don’t need pictures to recognize that QUICKidine, GRIZZLYofulvin, CARbamazepine, RifAMPin, and PHENPHEN (Phenytoin & Phenobarbital) are “fast” names.

No, I don’t know where the grizzly bear got the illegal drugs. I suspect his dealer was in the car, and the mosquito’s all “Dude, Phenphen isn’t legal. LET ME TAKE CARE OF THAT FOR YOU.”

Similarly, no one should need a poorly-drawn picture to recognize that ICEoniazid, ERRORythromicin, and CEMENTidine are “slow” names.

Why is there a block of cement in the middle of the ice rink? I don’t know. Maybe someone just hates that poor robot.

But then, where would be the fun in that?


Endocrinology is such a mixed, random bag of topics: ob/gyn, bones, diabetes, pituitary, thyroid.  (Which makes sense, since ‘Endocrine’ really just means ‘things secreting things that go places and do stuff“.  So this is not a system like cardiovascular is a system.  This is the “lost and found” box of physiology.)

It’s easy to motivate myself to learn about the obviously cool things – like birth control – or obviously important things, like menopause or diabetes.

It’s also easy to motivate myself to learn about the terrifyingly complicated things, like cancers.

But I have never been able to motivate myself to learn about bones.  It’s the worst thing ever:  Show me a picture of Haversian canals and – oh god, I need a Red Bull now.  That phrase is just awful.

The closest I’ve ever come to successfully learning about bone biology is knowing that osteoclasts absorb bone – because while in class, I’m supposed to be absorbing the bone information – but osteoblasts do the opposite, because blast, I never absorb anything.  (Osteocytes are grown-up osteoblasts.  Because since I never absorbed anything, when I grow up I will cite all bone information directly from a textbook.)

Luckily, since this is the 3rd time this year we’re learning about bones, now I can at least remember the names of those cells without that ridiculous mnemonic.  Progress!

But despite that, you could still say I have an intense Haversian to this material.


(… I’ll be here all week, folks!  Tip your waiters!)

Quote Of The Day: Can’t believe I missed that lecture.

Pathology Lecturer:  “My supervisor always told us we could really connect with the students if we memorized all of your names. So I had an even better idea! I decided to just give everyone a new name. So… “Bob!” What do you think of this slide – normocellular, or hypercellular?”

And he continued to call on students randomly, by made-up names, for the rest of the morning.  (I love pathologists.  They all do awesome stuff like that.)  (Hi, Boyfriend.  Way to pick your future specialty!  Ten points to Gryffindor!)

Anyway.  This same lecturer came up with a mnemonic for the causes of papillary necrosis.  It’s a solid mnemonic, but I always forget what syndrome the mnemonic is for… so I thought “Hey, maybe if I come up with a terrible pun and draw a picture of it, I’ll remember.”

(Or, let’s be honest, “Hey, I over-caffeinated myself and can’t sit still enough to study anymore!  How can I justify drawing awkward pictures instead.“)

How to memorize origins and insertions

Last night I got a question about how to memorize origins and insertions for anatomy.  My comment quickly turned into a book, so I figured I’d make it a post and call it a day.  Skip to the double astericks** if anatomy bores you.

You’re right, mnemonics don’t really work for muscle attachments -too many of them.  It demands a different strategy – here’s what I believe in:

1.  First, make a table.  I use 5 columns across the top of the page for “muscle name” “origin” “insertion” “action” and “innervation”.  If you’re feeling fancy, you can color-code, but it’s not necessary. Once everything you need to know is in one place for easy reference, memorizing it starts to seem possible – and you won’t be wasting time flipping pages around.

my favorite part is how Alex seems unconcerned about it.  He would

These folks have clearly just found out there are 600 muscles in the human body and they have to know at least 5 things about each one.

2.  Prioritize.  First, learn just the bone of attachment for each muscle. Then the process/part of the bone.  Then any absurdly specific details your professor wants you to know about that process. It’s okay if you don’t finish the 3rd pass – I sure didn’t – but you’d be surprised by how much further you’ll be ahead of everyone if you start each unit by memorizing what bones the muscles attach to.

What you want to avoid is trying to memorize the long and detailed version for each muscle before moving onto the next.  It’s all too easy for this to take so long that you run out of time.*  If you start with a quick pass of bones, then add detail, you’ll at least know enough about each muscle to guarantee an intelligent guess.

3.  Try memorizing by action. For example, most of the medial rotators of the arm attach to the intertubercular groove.  (Not the “floor of the” or “the lateral lip of the” or, god forbid, the “lateral 3/4 of the inner side of the”- at least not yet.  Those are low-yield details that you can hammer into your brain with flashcards the day before a test if you have time).  So, that’s great – but subscapularis is the exception.  How to remember subscapularis?  Well, I remember that the lateral rotators attach to the greater tubercle (because I made a list of where the lateral rotators attached)- so since the subscap is a medial rotator, by elimination I know it must attach to the lesser tubercle.

Also?  Fictional.

Okay, so this guy is probably capable of memorizing everything on the 1st try. But he also "aced his MCATs" and "cleverly has no personal life". So.

4.  Try memorizing by common insertion points. Making a list of which muscles attach at a given location (rather than the reverse) and doing some rudimentary memorization of that list can speed things up quite a bit.  (Only worth doing with common insertion points – greater trochanter, ASIS, etc.)  For example – the coronoid process of the ulna.  What attaches there?  The brachialis and a bunch of forearm muscles.  What do they have in common?  They’re all flexors – FDP, FDS, and FDP longus flex digits, while Pronator Teres and brachialis flex the elbow.

Cool.  Now I have two ways of potentially remembering this information during the test.  If I’ve forgotten Pronator Teres’ attachments, but I remember it’s a flexor – then I might remember that most flexors attach to the coronoid process.  If I’ve remembered its attachments but forgotten its secondary action, then I can just remember “hey, everything attached to the coronoid process is a flexor.  It must flex.”

“Too long, didn’t read” version: Get all the info down in one place and start by memorizing everything according to general attachments only.  Then group the info in various ways by writing simple lists, thereby increasing the number of ways you can remember it on the test.

Anyone else have any anatomy advice?

* For example, once you know that the brachialis attaches to the ulna (and not the radius)  – then you can start adding “coronoid process and tuberosity of the ulna” to your memory.  Otherwise, if you draw a partial blank on test day, it’s anyone’s guess what part of that sentence you might remember – maybe you’ll only remember “tuberosity”.  Not as helpful as “ulna”.
** Fun fact:  Shania Twain’s real name is Eileen Edwards.  If that doesn’t surprise you, then you should know that Tina Turner’s real name was Anna Bullock, and Tori Amos was really named Myra.  Hopefully this entry was now not a total waste of your time.

Coagulation Cascade: In Limericks!

It’s like Rule 34 of the internet… for science: If you can imagine it, there is a mnemonic for it. And somebody has put it on the internet.

So late last night, I was contemplating whether I should open my book and start diagraming the coagulation cascade (lame), or open the internet and search for mnemonics for the coagulation cascade (awesome). The internet won and Rule 34 (of science!) was proven correct again.

This may not be the most efficient way to memorize the coagulation cascade, but gosh darn it, it’s peer-reviewed, they made it rhyme, and they included regulation. Score one for science.

Coagulation Cascade: A Series of Limericks, by Mark A. Vande Haar and Karyn A. Fay