1. Palliate = Comfort, not Cure.

Recall: Palliative care focuses on relieving suffering and improving quality of life for patients with serious illnesses, not curing disease (A) or prolonging life at all costs (B).

2. ASA-6 for Safety Assessment.

Recall: ASA has 6 classes: I (healthy), II (mild systemic disease), III (severe systemic disease), IV (life-threatening), V (moribund), and VI (brain-dead organ donor).

3. Sickle = Six and Valine.

Recall: In HbS, valine replaces glutamic acid at position 6 of the beta-globin chain.

4. Ph+ = Philadelphia = CML.

Recall: Philadelphia chromosome [t(9;22)] producing BCR-ABL fusion is the hallmark of CML (>95% cases).

5. Eleven thousand = Elevated WBC.

Recall: Leukocytosis is WBC >11,000/μL (varies slightly by lab).

6. Bleeding time = platelet Problem.

Recall: Platelet disorders (quantitative or qualitative) cause prolonged bleeding time with normal PT/aPTT.

7. Inflix-i-MAB = Monoclonal AntiBody against TNF.

Recall: Infliximab is a TNF-alpha inhibitor.

8. Bisphosphonates Build bones first.

Recall: Bisphosphonates (alendronate, risedronate) are first-line anti-resorptive agents.

9. 6 and 11 = benign (warts), 16 and 18 = mean (cancer).

Recall: HPV 6 and 11 are low-risk types causing 90% of genital warts.

10. Exfoliative toxin EXFOLIATES the skin in SSSS.

Recall: Exfoliative toxins (ETA and ETB) from S. aureus phage group II cleave desmoglein-1, causing superficial epidermolysis in SSSS.

11. Secondary syphilis = Soles and palms (S and P).

Recall: Secondary syphilis causes symmetric, maculopapular, non-pruritic rash involving palms and soles – this distribution is highly characteristic.

12. Tonsurans = Tonsured head = scalp infection in children.

Recall: Trichophyton tonsurans is the most common cause of tinea capitis in children (in most countries).

13. Pemphigus = suprabasal (intraepidermal), Pemphigoid = below epidermis (subepidermal).

Recall: Pemphigus vulgaris causes suprabasal acantholysis (split just above basal layer) due to loss of desmosomal adhesion.

14. Pompholyx = Palms and soles with Pearls (vesicles).

Recall: Pompholyx presents with intensely pruritic, deep-seated vesicles on palms, soles, and lateral fingers (like tapioca pearls).

15. Malassezia = Master of seborrheic areas.

Recall: Seborrheic dermatitis is associated with Malassezia yeasts (M. globosa, M. restricta), though the exact pathogenic role is debated.

16. 2 years = 2/3 of adult brain size achieved.

Recall: Head circumference is measured until 2 years because brain growth is most rapid during this period.

17. CBC = C comes first (Complete evaluation).

Recall: CBC provides hemoglobin, hematocrit, RBC indices, and WBC/platelet counts–essential for initial evaluation.

18. Conjunctiva = Consistent for pallor.

Recall: Conjunctival pallor is the most reliable sign of anemia in children as it is less affected by skin pigmentation.

19. Counsel the whole family tree.

Recall: Since thalassemia is autosomal recessive, siblings and extended family may be carriers.

20. Thalassemia = Tremendous spleen.

Recall: Thalassemia major causes massive splenomegaly due to extramedullary hematopoiesis and RBC sequestration.

21. PTT = ‘Partial’ intrinsic pathway.

Recall: PTT measures intrinsic pathway factors (VIII, IX, XI, XII).

22. ALP = Always elevated early.

Recall: Alkaline phosphatase (ALP) rises early as osteoblasts attempt to mineralize bone.

23. 15 is fine – for fine work.

Recall: Blade 15 is small and curved, ideal for precise, delicate skin incisions such as in hand surgery or excision of small lesions.

24. 18 to consent, adult and competent.

Recall: In most countries, 18 years is the age of majority, allowing independent consent.

25. Staph on skin, starts surgical infections.

Recall: Staphylococcus aureus is the most common cause of surgical site infections, especially in clean wounds, due to skin colonization.

26. 3 liters a day keeps dehydration away.

Recall: Adults require approximately 30–35 mL/kg/day, translating to 2500–3000 mL for average adults.

27. Gibbus = TB hump.

Recall: TB causes vertebral body destruction with anterior wedging leading to kyphotic “gibbus” deformity.

28. Bend forward, see the hump – Adams test.

Recall: Adams forward bend test reveals rib hump (rotational deformity) indicating structural scoliosis.

29. Flaccid and floppy = polio paralysis.

Recall: LMN destruction causes flaccid, areflexic paralysis with muscle atrophy.

30. Doppler = dynamic blood flow.

Recall: Doppler ultrasound uses frequency shift of sound waves to assess blood flow direction and velocity in real-time.

31. Autonomy Always trumps when the patient is Alert.

Recall: A competent patient has the right to refuse or withdraw any treatment, including mechanical ventilation.

32. High CHA₂DS₂ = High stakes = Bridge needed.

Recall: Patients with high thromboembolic risk (CHA₂DS₂-VASc ≥5) should receive bridging anticoagulation with LMWH when warfarin is held for surgery.

33. Beta-thal = Boosted A2.

Recall: Elevated HbA2 (>3.5%) is diagnostic of beta-thalassemia trait, resulting from reduced beta-globin synthesis with compensatory increase in delta chains (HbA2 = α2δ2).

34. Philadelphia = Ph+ CML = 9-22.

Recall: Chronic myeloid leukemia (CML) presents with marked leukocytosis showing full myeloid maturation spectrum (left shift to blasts), basophilia, and the Philadelphia chromosome t(9;22) creating BCR-ABL1 fusion. t(15;17) (A) is APL. t(8;14) (C) is Burkitt lymphoma. t(14;18) (D) is follicular lymphoma.

35. Psoriatic = Pitting nails + Puffy sausage fingers + DIP.

Recall: Psoriatic arthritis presents with dactylitis (sausage digits from entire finger inflammation), DIP involvement (unlike RA), nail changes (pitting, onycholysis), and asymmetric oligoarthritis in association with psoriasis.

36. Can’t see, can’t pee, can’t climb a tree = NSAIDs for reactive arthritis.

Recall: Reactive arthritis (formerly Reiter’s syndrome) is a seronegative spondyloarthropathy triggered by GI or GU infection, presenting with the classic triad of arthritis, urethritis, and conjunctivitis.

37. Blood on dipstick but no Blood cells = myogloBinuria from rhabdomyolysis.

Recall: Rhabdomyolysis causes myoglobinuria (positive dipstick for blood without RBCs–myoglobin cross-reacts).

38. ASA III = 3 strikes of severe (but survivable) disease.

Recall: ASA III indicates severe systemic disease that limits activity but is not immediately life-threatening (e.g., poorly controlled diabetes, moderate COPD, morbid obesity).

39. AZT = mitochondriAl toxicity.

Recall: Zidovudine (AZT) causes mitochondrial toxicity leading to myopathy with elevated CK, proximal weakness, and ragged-red fibers on biopsy.

40. “Black DOTs = Dots Of Thrombosed capillaries” – characteristic of warts.

Recall: Common warts (verruca vulgaris) are caused by HPV and present as flesh-colored, dome-shaped papules with a rough, hyperkeratotic surface.

41. PPE in HIV = Persistent Pruritic papules Everywhere.

Recall: Pruritic papular eruption (PPE) is one of the most common cutaneous manifestations of HIV, presenting as chronic, itchy papules on trunk and extremities.

42. ENL = Erythematous Nodules with Lots of systemic symptoms.

Recall: Type 2 lepra reaction (Erythema nodosum leprosum/ENL) occurs in lepromatous and borderline lepromatous leprosy.

43. Azelaic Acid = Attacks pigment production.

Recall: Malassezia furfur produces azelaic acid, which inhibits tyrosinase enzyme and reduces melanin synthesis, causing hypopigmentation.

44. Candida = Cottage cheese discharge with Satellite pustules.

Recall: Vulvovaginal candidiasis presents with intense pruritus, thick white “cottage cheese” discharge, erythema, and characteristic satellite pustules at lesion margins.

45. Systemic Steroids = Stop the autoimmune attack in pemphigus.

Recall: Systemic corticosteroids (prednisolone/prednisone) are the first-line treatment for pemphigus vulgaris due to its autoimmune nature and potentially fatal course if untreated.

46. Emollients = Essential foundation for all Eczemas.

Recall: Emollients (moisturizers) are the cornerstone of eczema management as they restore the impaired skin barrier, reduce xerosis (dryness), and decrease the need for topical corticosteroids.

47. Civatte = Cells dying (apoptosis) at the basal layer in LP.

Recall: Lichen planus histology shows: (1) Band-like (lichenoid) lymphocytic infiltrate at dermal-epidermal junction, (2) “Saw-tooth” irregular acanthosis, (3) Civatte bodies (apoptotic keratinocytes, also called colloid/hyaline bodies), and (4) Hypergranulosis.

48. Strep = most common Stimulus for erythema nodosum.

Recall: Streptococcal infection (particularly pharyngitis) is the most common identifiable cause of erythema nodosum worldwide.

49. CARBUNCLE = CLUSTER of furuncles with multiple openings.

Recall: Carbuncle is a cluster of interconnected furuncles with multiple draining sinuses, commonly on the back of neck in diabetics.

50. Oil drop = Only in Psoriasis (nail bed pathognomonic sign).

Recall: Oil drop sign (salmon-colored patches under the nail plate) is highly specific for psoriasis, representing psoriatic involvement of the nail bed.

51. Play your way to a good exam day.

Recall: Using play techniques like blowing on a pinwheel or tissue paper encourages deep breathing naturally and makes the examination child-friendly.

52. No A, lots of F = Major problem.

Recall: Absent HbA with elevated HbF (95%) indicates complete absence of beta-globin chain synthesis, characteristic of beta-thalassemia major (Cooley anemia).

53. Retics Rise First (day 3-5), then Hemoglobin follows.

Recall: Reticulocytosis is the earliest sign of response to iron therapy, occurring within 3-5 days.

54. Anemia = Fast heart + Flow murmur.

Recall: Severe anemia triggers compensatory tachycardia to maintain oxygen delivery.

55. 21-day cycle = Cyclic neutropenia.

Recall: Cyclic neutropenia is characterized by regular oscillations in neutrophil counts (typically every 21 days) with symptomatic episodes during nadirs.

56. Massive spleen = Chronic myeloid leukemia, Malaria (chronic), Myelofibrosis.

Recall: Massive splenomegaly (>8 cm below costal margin) is classically associated with CML, thalassemia major, and visceral leishmaniasis in children.

57. Von Willebrand = vWF carries Factor VIII + helps platelet plug.

Recall: Von Willebrand disease (most common inherited bleeding disorder) presents with mucocutaneous bleeding, prolonged bleeding time (platelet dysfunction), mildly prolonged aPTT (low vWF reduces Factor VIII), and family history of bleeding.

58. Flexible = Arch appears on tiptoe = Normal.

Recall: Flexible flat foot is normal in young children.

59. No sun + No supplement = No vitamin D = Rickets.

Recall: The combination of exclusive breastfeeding, limited sun exposure (maternal covering reduces vitamin D transfer), classic bone findings, and skeletal deformities indicates nutritional vitamin D deficiency rickets.

60. Becker = Better prognosis, later onset; Duchenne = Devastating, early onset.

Recall: BMD is milder than DMD, with later onset (5-15 years), slower progression, ambulation often maintained into 20s-30s, and longer survival.

61. “D5W = Dilutes 5 Ways” – giving too much drops sodium.

Recall: Excessive administration of hypotonic fluids (5% dextrose is essentially free water) causes dilutional hyponatremia, especially postoperatively when ADH is physiologically elevated.

62. Consent PROTECTS – Patient Received Other Treatment options, Explanation of Complications, Took Signature.

Recall: Valid informed consent documenting that the specific complication was explained and accepted by the patient provides legal defense against negligence claims for known risks.

63. Septic joint = Surgical EMERGENCY – Drain Don’t Delay.

Recall: Septic arthritis requires urgent surgical drainage (arthroscopic or open) combined with IV antibiotics to prevent cartilage destruction.

64. MARJOLIN = Malignancy After Repeated, Long-standing Inflammation at Old chronic wound.

Recall: Marjolin’s ulcer is squamous cell carcinoma arising in chronic wounds, burns scars, or draining sinuses of osteomyelitis.

65. Bent forward? BREAK and BALANCE spine with osteotomy.

Recall: Severe kyphotic deformity in ankylosing spondylitis may require corrective osteotomy (pedicle subtraction or polysegmental) to restore sagittal balance and improve horizontal gaze and respiratory function.

66. “ENhancing = Expect Neoplasm” – tumors have blood supply and enhance.

Recall: An enhancing irregular filling defect in the bladder strongly suggests transitional cell (urothelial) carcinoma.

67. PSEUDO = False cyst (no epithelium) after Pancreatitis.

Recall: Pancreatic pseudocyst develops after pancreatitis as a collection of pancreatic fluid contained by fibrous/granulation tissue (no epithelial lining).

68. XANthochromia = eXamine ANeurysm with CT angiography.

Recall: Xanthochromia in CSF with negative CT indicates subarachnoid hemorrhage (CT sensitivity decreases after 6 hours).

69. TUNICA TORN = Testicular contents pour out = Rupture (requires Repair).

Recall: Testicular rupture shows disruption of tunica albuginea with extruded testicular contents – surgical emergency requiring exploration and repair.

70. SNOW in uterus + SKY-high βhCG = molar pregnancy (Snowstorm).

Recall: Complete hydatidiform mole shows “snowstorm” or “cluster of grapes” appearance on ultrasound due to multiple swollen chorionic villi, with markedly elevated β-hCG and absent fetal parts.

71. TUG over 12, fall risk is the concern to solve.

Recall: A TUG time greater than 12–14 seconds indicates increased fall risk and warrants comprehensive falls assessment, including gait analysis, vision, medications, and home safety evaluation.

72. IV iron when the gut is the source of concern.

Recall: This patient has severe iron deficiency anemia (low ferritin, low transferrin saturation) from gastrointestinal blood loss.

73. Allo before chemo flow–prevent uric acid’s glow.

Recall: For intermediate-risk TLS (DLBCL with bulky disease), prophylaxis with allopurinol starting 2–3 days before chemotherapy plus IV hydration is standard.

74. HIT = Heparin Is Trouble; switch to non-heparin on the double.

Recall: High 4Ts score (7) indicates likely heparin-induced thrombocytopenia (HIT).

75. When OA stairs are steep, duloxetine is next to keep.

Recall: Duloxetine, an SNRI, is FDA-approved for chronic musculoskeletal pain including knee OA and is appropriate for patients who have failed first-line agents and are not surgical candidates.

76. IBM = Insidious, Boy those finger flexors and quads are going.

Recall: Inclusion body myositis (IBM) presents in patients >50 years with insidious asymmetric weakness affecting finger flexors and quadriceps, mild CK elevation, and mixed EMG pattern.

77. Myeloma transplant is not about the birthday–fitness is the pathway.

Recall: ASCT eligibility is determined by physiologic age, performance status, and organ function–not chronologic age.

78. Pregnant + Pox exposure = Passive immunoglobulin Protection.

Recall: Varicella-zoster immunoglobulin (VZIG) is indicated for susceptible pregnant women exposed to VZV, ideally within 96 hours but effective up to 10 days post-exposure.

79. ENL = Erythema Nodosum = Thalidomide.

Recall: Type 2 reaction (ENL) occurs in borderline lepromatous and lepromatous leprosy, presenting with tender subcutaneous nodules, fever, arthralgia, and systemic inflammation due to immune complex deposition.

80. Isotretinoin + Papilledema = Pseudotumor = Pause immediately.

Recall: Isotretinoin can cause pseudotumor cerebri (idiopathic intracranial hypertension), especially when combined with tetracyclines.

81. 6 Ps of LP: Purple, Polygonal, Planar, Pruritic, Papules + striae of Wickham.

Recall: Wickham striae are the characteristic fine white lines on the surface of lichen planus papules, corresponding to wedge-shaped hypergranulosis histologically.

82. Herpes = Heralded by tingling; Impetigo = Instantly honey-crusted.

Recall: Herpes labialis presents with grouped vesicles on an erythematous base with prodromal symptoms (tingling, burning) due to HSV reactivation.

83. Lichen Sclerosus = Squamous risk + Sclerotic skin.

Recall: Lichen sclerosus presents with white, atrophic, “cigarette paper” plaques on vulvar/genital skin with characteristic histology (epidermal atrophy, homogenized collagen, lymphocytic band).

84. Warfarin Necrosis = Protein C depletion Without bridging.

Recall: Warfarin-induced skin necrosis occurs in patients with protein C or S deficiency when warfarin is initiated without heparin bridging.

85. Hypo-Hypo (hypotonia + hyporeflexia) = Hunt for neuromuscular cause.

Recall: Hypotonia with diminished deep tendon reflexes suggests a lower motor neuron lesion or primary muscle disease such as spinal muscular atrophy or congenital myopathy, warranting urgent investigation.

86. Sequestration = Spleen swells, cells disappear – transfuse with care.

Recall: This is acute splenic sequestration crisis – rapid trapping of red cells in the spleen causing life-threatening anemia and hypovolemic shock.

87. Hydroxyurea = HbF UP, crises DOWN.

Recall: Hydroxyurea is the first-line disease-modifying therapy for children with sickle cell disease who have had severe complications (acute chest syndrome, recurrent painful crises, severe anemia).

88. Sibling Match = Best Chance for cure.

Recall: Allogeneic HSCT from an HLA-matched sibling donor is curative, with >90% disease-free survival in Pesaro Class I patients (no hepatomegaly, no portal fibrosis, adequate chelation).

89. Parvo = Pauses Progenitors = aplastic crisis.

Recall: This is aplastic crisis – transient red cell aplasia caused by parvovirus B19 infection in patients with underlying chronic hemolytic anemia.

90. No K at birth = Bleeding at 3 days; give K!

Recall: This is classic vitamin K deficiency bleeding (VKDB, formerly hemorrhagic disease of the newborn) in an infant without vitamin K prophylaxis.

91. MTX fails = Move to TNF inhibitors.

Recall: RF-positive polyarticular JIA behaves like adult rheumatoid arthritis and often requires biologic therapy.

92. Tetany = Tense situation, give IV calcium immediately.

Recall: Symptomatic hypocalcemia with tetany (carpopedal spasm, Chvostek sign) is a medical emergency requiring immediate IV calcium gluconate (10% solution, 1-2 mL/kg over 10-20 minutes with cardiac monitoring for arrhythmias).

93. Pompe = Pronounced cardiomyopathy + glycogen storage.

Recall: Infantile-onset Pompe disease (acid alpha-glucosidase/GAA deficiency) presents with hypotonia, weakness, cardiomegaly (hypertrophic cardiomyopathy), hepatomegaly, and respiratory failure.

94. Robot fails, scalpel prevails – always be ready to convert.

Recall: Safe warm ischemia time for renal parenchyma is approximately 20-30 minutes before irreversible damage occurs.

95. Day 5-8, serosanguinous fate–if malnourished, fascia can’t regenerate.

Recall: Fascial dehiscence typically occurs on days 5-8 postoperatively when sutures are holding tissue together rather than healed fascia.

96. Insulin shifts three inside: P, K, and Mg hide.

Recall: This patient has not yet received nutrition but is receiving IV fluids likely containing dextrose.

97. Active TB = Active infection – resect first, replace later.

Recall: Arthroplasty in active tuberculosis carries high risk of periprosthetic infection and implant failure.

98. Posterior pedicle power = Modern AIS mainstay.

Recall: Modern posterior spinal fusion with pedicle screw instrumentation has become the dominant approach for adolescent idiopathic scoliosis due to superior coronal and rotational correction and ability to fuse fewer levels than anterior approaches.

99. Pheo = Fat-poor + Functional + Fails fast washout.

Recall: Absolute percentage washout = [(Enhanced HU – Delayed HU)/(Enhanced HU – Non-contrast HU)] × 100 = [(110-85)/(110-35)] × 100 = (25/75) × 100 = 33.3%.

100. Pelvic support osteotomy = Bone substitutes for missing muscle.

Recall: Pelvic support osteotomy (valgus-extension proximal femoral osteotomy) redirects body weight transmission through the abducted femur, reducing demand on paralyzed hip abductors.