#14: Memory Palace for CAH

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How to memorize Congenital Adrenal Hyperplasia.  The bonus PDF walks you through how to build a memory palace, with slides for concepts, tips, and practice questions.  Get the PDF by entering your info below.

You may not need to memorize CAH now, but I think this topic illustrates a few great principles about how to maximize efficiency in medical school.  

  1. Recognize the high yield.  CAH is a well-characterized disorder with very clinically disparate presentations, so it is perfect for boards questions.  It’s also what I call “low hanging fruit” – that is, if you have these memorized right, you pick the answer quickly and move on.  It’s an easy win.
  2. Make memes.  In my palace for CAH, there are many frequent friends.  Hyper/hypotension is a great example.  For hypertension, I usually had my characters doing something frantic, usually running around or exercising.  For hypotension, I had them do the kind of Elaine dance from Seinfeld, but super slow and loosey-goosey.  I used these memes so many times it’s ridiculous.  
  3. Concepts are king.  While it’s easy to have a hypertension meme in the palace and jump to the right answer, to really feel confident on test day you also need to understand WHY 17-a hydroxylase deficiency leads to hypertension while 21-hydroxylase deficiency leads to hypotension.
  4. The memory palace keeps information organized.  This is one of the beauties of this memory technique.  You’ll never struggle to remember which CAH has a male vs female phenotype, because they aren’t in the same places in your palace at all.

But let’s get into the actual building of the palace.  CAH is really straightforward because you need 4 rooms, or 4 corners of a big room (as long as you can keep the spaces separate in your mind).  Then you put one manifestation in each room: 17a-hydroxylase, 21-hydroxylase, 11B-hydroxylase, and 3B-HSD.  

For the 17a-hydroxylase, you’ll need to remember these buzz facts:

  • Hypokalemia
  • Hypertension
  • Pseudohermaphrodite XY
  • Increased mineralocorticoids/aldosterone

I’m including an excerpt from my Word document in the slide deck.  Always remember to document, so that when you have to study for step 1, or refresh for step 2, the information comes back quickly.  Put your memes to work here.  For me, aldosterone was really flashy shoes, from Aldo the shoe store.  So in that area of my CAH palace, the characters all had ridiculous clunky high heels, including a hippo – my meme for hypokalemia.  A hippo walking around in fabulous high heels was a very sticky image for my palace.

Another mnemonic trick for memorizing CAH is that it helps to use the numbers as ages.  So in this area of my palace, the characters were all about 17 years old.  I feel like we all can make a pretty good image of what a group of 17-year-olds look like, versus 11-year-olds or 21-year-olds.  So that is really helpful here.

Check the slide deck for the buzz words you should include for the other three rooms in your palace.  If you are asking how I knew what to include, go back to my 5-part study strategy, which I teach in my online course.  There are a few ways to identify the high-yield information to include in your palace.  First Aid is a great way to make sure you haven’t missed anything critical.

Now, don’t forget the concepts.  The slide deck has three discussion questions for you to review with your study group.  The take-home point here is that the palace is a quick and easy way to organize the information, but it doesn’t replace understanding why the genitalia in each disorder develop a certain way, or how the adrenal steroid synthesis pathway works.  

I’m going to go on a little tangent here about the steroid synthesis pathway.  I did not put that into a palace, and I had to memorize it a few times.  Another great point about the memory palace.  Not everything can go into a palace.  The steroid synthesis pathway has a few paths in a very specific sequence. If it were one pathway, and linear, I think a walk through a memory palace could work, in the classical sense that the ancient Greek poets did it.  But when there are a lot of pathways, you’d have to find the *perfect* location.  And in each loci there would just be one enzyme or hormone.  I didn’t feel like that was a great use of a space.  So instead I borrowed an idea from a friend – she made up a narrative about a 17-year-old girl who was pregnant and alone (pregnenolone) and drew out the sequence over and over until it stuck.

I included one practice question on the slide deck, so you could see how these kinds of questions would be posed on exams or boards.  You can see how straightforward these questions are and why writers would be tempted to use them.  So make sure you have a good CAH palace and have some easy points in your pocket.

I hope this podcast about CAH helped illustrate some fundamentals about the memory palace and how it works.  If there’s a topic you are struggling to memorize, send me an email and I’ll create a podcast around your topic.

Again, get the PDF by entering your email here:

Listen to the podcast here!

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