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5 Votes

How to memorise anything using dota

September 4, 2016 by earlybird92
Comments: 6    |    Views: 12327    |   

Hero Build

DotA2 Hero: Underlord

Hero Skills


1 3 5 7

Pit of Malice

2 4 6 8

Atrophy Aura

9 10 11 12

Dark Rift

13 14 16


15 17 18


I Know what you are thinking. Wall of text! Waste of time. Me want read pitlord guides. What is this nonsense?

Why you should read this guide
This guide is great for you if you are a student who has to memorize lots of stuff. Given that DOTA players are mostly in the 13-25 age group, I assume that to be the case.

Ever wish that studying could be as interesting as playing computer games? Ever wondered why you can remember the skills and stats of this newly released hero, yet struggle to remember the simplest of things for your upcoming test? Well look no further

TLDR: This guide will increase your memory capacity. You do better in school with less effort and time spent.

What is so different about this guide compared to other memory guides out there? Well, it is not that much different really, but I feel that my approach is more realistic. Most memory websites I frequent teaches you too memorize too simplistic stuff like cards, shopping cart items, numbers, binary numbers (all of which I am familiar with ), but none of them really focuses on school work. To me, memorizing study material is more complex than memorising random assortment of numbers/cards because

1) You can convert numbers/ cards into familiar characters/memory devices. You can't really do that when you study something like biology or medicine with thousands of different terms

2) Memorising things in a shopping list(milk/eggs/apples/chicken) is easier than memorisng words like (mitochondria/ uterus/ ilioinguinal nerve/ xiphoid process) because you will not intrinsically know what these new words mean when you memorise them. An additional step of understanding and finding meaning is essential to memorise such material effectively

I take my references from wikipedia, as well as the books written by tony buzan, domonic o brein and ron white.


Hi everyone, earlybird here. This guide will be a guide unlike any other.(i checked). Whilst using computer games as a mnmonic/memory technique/memory palace is not new, no one has yet to write a guide on how to use DOTA as a means to memorise large amount of stuff. After some practice with the techniques outlined below, you would improve your memory capacity by quite a bit.

About myself.
I am a medical student who has to memorise lots of stuff. I am also an avid DOTA 2 player.

What makes me qualified to write this guide

I am able to memorise 2 decks of playing cards in slightly over 13 minutes(all suits, numbers and positions). While that is approximately 3 times slower than the current world record(held by dominic o brein), I am able to recall with around 95% accuracy the entirety of the 2 decks the next day. If I recall the deck 2 more times in the week, I would be able to recall with 95% accuracy, the suit number and position of all 104 cards in the next week.

Oh i have passed 4 years of medical school, that has to be something. Right? No?

Why does DOTA work as a mnmonic

The foundation of memory is very simple and can be split into 3 categories,
1) physiological (Getting enough sleep, nutrition, energy levels etc)
2) State of mind
3) Technique.

State of mind--> Face it, 95% of what you are studying isn't interesting to you. Sure, you can be passionate about a particular topic you are studying, but I have yet to meet a person that is passionate about everything. Life sucks. Studying sucks.

But gaming rocks. Everything about gaming gets siphoned into your mind at lightning speed because you are passionate and interested in the game. Hell, you would scream at your mother for interrupting your ranked game for something as trivial as dinner. Right?

TLDR: You memorize things better when you are interested. DOTA is more interesting than school work

3) Technique

The fundamentals of memory are
A) Location
B) Association
C) Imagination

Basically, the secret is to use things already in your long term memory as "Pegs" to help you remember information that usually goes into short term memory. EG, I doubt any of you would every forget your address, your name, the arrangement of furniture in your room.

Dota 2 (and most video games) basically have all 3 elements. A) There are memorable locations(fountain, secret shop etc) B) There are lots of different heroes with different skills C) it is set in a fantasy universe, so anything can happen

TLDR: You can use DOTA to help you study more effectively. A plus point is that you can actually revise your schoolwork while playing your favorite game!

Other mnmonic techniques

I employ a variety of memory techniques in my study. However, I will just be sharing the main way I use to study medical text, which is a variation on the memory palace/roman room systems.

Other memory techniques that I am familiar with(but I won't be covering them unless this guide gets popular for some weird reason) includes
1) The major system (translating numbers into words)
2) The dominic system (translating numbers into famous people)
3) Number shape/peg system
4) Alphabet system

If I have the time, I will edit the guide to contain a section on a modified form of the alphabet system using DOTA 2 items
Clarity etc as memory pegs. It should be fun!

TLDR: This guide is a variant on the roman room memory technique

Step by step guide to studying (preparation)

RULE no1. Less information is easier to remember than more information. For example, it is easier to remember a list of 5 objects compared to 50 objects.

Rule no.2. More vivid information that you add by yourself is easier to remember. Eg it is easier to remember a massive silver BMW with rocket launchers and sub-machine guns on the bonnet than a plain old car.

Let me give you an example. Imagine you are a medical student in your surgical term and you have to answer these questions

1)What is a hernia? Name some types of hernias and how common they are
2)General anatomy of the area, including:
2a)Inguinal canal Vs Inguinal ligament,
2b)deep ing ring vs superficial ring,
2c) ing canal borders,
2d) ing canal contents (Male vs female)
3) What is the anatomical difference between an inguinal hernia and a femoral hernia?
4) On examination, what is the difference between an inguinal hernia and a femoral hernia?
5) What is the importance of deciding whether a hernia is inguinal or femoral?
6)What is the difference between an incarcerated or irreducible hernia, and a strangulated hernia?
7) How do you do a hernia examination?

A) The first thing you have to do is to sieve out intrinsic knowledge. What do I mean by that? There are certain bits of information that are either common sense or studied extensively already. For example , I know that I do not have to study question 2a) and 2d) 5) 6) because I already know these things by heart.

B) Next you should cross reference sources to obtain the correct answers for the questions that you cannot answer. This should take the longest time because there is no shortcut to this. It is very important to do your homework because the last thing you want is to be memorizing the wrong thing.

C) Summarize your answers to the shortest form possible.

Lets use question 2b as an example

This is bad: The deep inguinal ring (internal or deep abdominal ring, abdominal inguinal ring, internal inguinal ring) is the entrance to the inguinal canal. The surface marking of the deep inguinal ring is classically described as half an inch above the midpoint of the inguinal ligament. However, the surface anatomy of the point is disputed. In a recent study etc

This is still bad: Midpoint of inguinal ligament. lateral to the epigastric vessels. The ring is created by the transversalis fascia,

This is ideal: Inguinal ligament(midpoint), epigastric vessels(lateral), transversalis fascia(origin)

TLDR: Make your notes as short as possible. Don't worry that your short notes makes little sense to other people(and to yourself). The idea is that if you memorise a few important keywords, you can piece together the whole story.

Things to not do

Don't be an idiot like many students. Many people write notes(some people write beautiful notes in prose. ugggh) and don't bother remembering them. When the exam comes, they stare at the notes, go blank, and realize that they remember absolutely nothing. Don't do that. Memorization of material is

1) Fun, if you do it right
2) Not time consuming at all relative to the time it takes to write and research the notes. I generally memorize information in 1/4 the time it takes to gather them and compile them in word
3) Much easier to do, when you don't have a deadline. When you cram everything into the last week, you become less efficient at memory due to increased cortisol levels and catecholamines. Even though you may pass your exam via cramming, you will probably forget everything in 2 weeks, and in courses where knowledge is spiraled down, this can spell disaster for you

TLDR: Memorise your notes after you write them. It does not take much time. Review the day after. The magic of my memory technique is that you can automatically revise your material by playing a game of dota. For example, if I link hernia examinations to Pitlord(or underlord), I would just play a quick game with him.

Step by step guide to studying Question 1a (establishing loci)

Okay, Lets review the material I am going to memorize

Underlined bits are not memorized because it is intrinsic knowledge to me

1)What is a hernia? Name some types of hernias and how common they are

ANS(summarized into word form):
Definition: Protrusion, wall of cavity normally resides.
Common hernias
1) Inguinal hernia (75% abdo hernias), Indirect(2/3), direct(1/3)
3) Umbilical
4) Incisional (surgery)
5) Diaphraghmatic

Rarer hernias
1) abdo hernias ,epigastric, parastomal,
A)Spigelian(spigelian fascia, aponeurosis between rectus abdominis and semilunaris. interparietal = between muscle; reduced swelling),
B)Richters( antimesenteric wall of the intestine, dangerous ,strangulation, laparaoscopic operations)

When attempting to memorise anything via the roman room method, the first thing to do is to establish loci. That loci can be anything from the objects in your room, famous people you know in alphabetical order etc, so long as you know them very well, can visualize them in your head, and there is a logical order to them so you don't get confused with regards to what came first.

Chronological order isn't so important for studying hernias, but it can be rather essential for things that require you to remember the exact order of steps eg. History dates, life cycle of a virus etc

For the purpose of this guide I will use Pitlord as an example of a loci. Dota Heroes are fantastic because they have many properties which make them good memory pegs. The gold standard for memory pegs is 5 objects in a room in clock/anti clockwise order. For example, if you use your bedroom, the order can go like this

1) Bed
2) Lamp
3) Fan
4) table
5) Dustbin

Most Dota heroes apart from invoker and doom(with devour) have 4 skills. Those 4skills + the hero itself makes 5 points of loci. 5 is the ideal number to make a room in a memory palace because

1) 5 is a rather whole number. 10 is the ideal, but having too many objects can be confusing

2) The human short term memory is capable of memorising 7 +- 2 objects with ease

TLDR, the following will be the points of loci we will use to memorise the answer to question1

1) Pitlord
2) firestorm
3) pit of malice
4) atrophy aura
5) dark rift

What if you run out of space?? well just use another hero to hold the rest of the information. I like to pick heroes that are related to each other to hold the same things. For example, I picture doom and pit lord to be related because they are both obviously demons, fat, and it is not hard to imagine fat heroes having a large disgusting hernia hanging from their abdomen.

Step by step guide to studying Question 1a) (association+ imagination)

Just a quick recap, the technique to memorising things using a roman room involves

1) Location
2) association
3) imagination

We are now at step 2 and 3, which means that we have to somehow link pitlord and his 4 skills to these words

Definition: Protrusion, wall of cavity normally resides.

Stats: Inguinal hernia (75% abdo hernias), Indirect(2/3), direct(1/3)

Rare abdo hernias: epigastric, parastomal, A)Spigelian(spigelian fascia, aponeurosis between rectus abdominis and semilunaris. interparietal = between muscle; reduced swelling),
B)Richters( antimesenteric wall of the intestine, dangerous ,strangulation, laparaoscopic operations)

Lets begin
1) Link Pitlord to definition of hernia (Protrusion, wall of cavity normally resides.)

The best way to link something unrelated is using your imagination, converting many words into a single picture, and making it as vibrant and interesting as possible. Ways to make things interesting includes humor, sexual jokes(I love ***** jokes), exaggeration of size and number, color, smell etc.

Imagine: Pitlord in all his glory, armor and bulk clutching a gaping hole in his armor, which is his only weakness--> a monstrous looking hernia that reminds you of an ischemic ***** (reminding you of the word protrude). Pitlord grabs his hernia and smashes it into the sidewall of your home(wall+ normally resides) leaving behind a massive crater(cavity)

You can change this story and exaggerate it as much as you like to make it more memorable, but follow the following rules
1) Just use the association that first comes to your mind(saves time)
2) there is no need to be a perfectionist, you can imagine whatever you want
3) Keep a short note of the most essential links so that you can revise your work later
4) Don't attach more than 2 images to a single point of loci. If you are a beginner, start off with just one, just like in this example
5) Images(or mental movies) can be used to memorize multiple individual words


TLDR:What to write in your notes
Picture: Pitlord with a ***** like hernia smashing the wall of your home with his hernia leaving behind a crater

(***** like)= protrude
(wall of home)= wall normally resides
(crater)= cavity

Notice that I did not bother to memorise the start of the definition as in wiki " Protrusion of an organ or part of an organ/ viscus through etc....". This is because I feel that that fact is common sense and there is not point incorporating it in the image above.

Remember: The less content you commit to your memory technique, the faster it is to memorise. Don't memorise things that are common sense or intrinsic knowledge.

Step by step guide to studying Question 1b)

Note* Even though the existence of inguinal hernias is intrinsic to me (I also know that indirect hernias(children) are more common than direct hernias(adult males)) I didn't know the exact ratios of indirect to direct hernias, so that will be the only thing i will focus on in the first part. (I also know that inguinal hernias are 75% of abdo hernias)

Things to memorise
1) Inguinal hernia (75% abdo hernias), Indirect(2/3), direct(1/3)
Rarer hernias
1) epigastric, parastomal,

1) I want to make an image with 1).The epigastric region of the abdomen is the top middle box, so I shade that box. stomas (especially in Haartman's procedure is usually in the left middle quadrant(left lumbar), so I draw a bag there. The inguinal region is the bottom row of boxes. In order to remember to remember the ratio of indirect to direct hernia, I draw a large oval over the last row of boxes and color in 2 thirds of it.

Next: I have to link this image to rain of fire. I imagine green flames coming in waves and crashing down onto the ground in the tic tac toe box fashion, burning the epigastric are predominantly, laying waste to a bag full of **** in the left side, and making my 2/3 circle.

Notes* memorise the image of a burning tictac toe with a bag and certain coloured areas and a 2/3 shaded circle

Step by step guide to studying Question 1c)

Things to memorise
A)Spigelian(spigelian fascia, aponeurosis between rectus abdominis and semilunaris. interparietal = between muscle; reduced swelling),
B)Richters( antimesenteric wall of the intestine, dangerous ,strangulation, laparaoscopic operations)

Firstly, spigealian sounds like an animal species with the face of steven spielberg (spigelian fascia)= Spielberg species + face.
Rectus Abdominus is simply your abs and semilunaris is just the middle bit of your abs in the midline that girls swoon over.

Image for Spiegalian hernia :
Steven spielberg with massive abs with a lunar moon drawn on top is clenching a very very very tiny marble in the shape of a hernia, making it almost impossible to see.

Note* Richter's sound like rich person and the richest person i know is bill gates. Richters hernia is best described with the following image taken from surg wiki which i hold absolutely no rights to

That to me looks like 2 snakes, and the snake on top has curled up on itself. Together, they look like a snake belt (the top snake being the buckle)

Image for Richte's hernia:
Bill gates is wearing absolutely nothing except his snake belt around his waist. In his hands, he holds laparoscopic equipment which is firmly lodged in his abdomen.

Final Image to throw in these facts
A) Pit of malice
B) Richters hernia is dangerous because of strangulation

Pit lord casts pit of malice and 2 combatants must fight. Only 1 may live and the other must die! I imagine the DOTA 2 announcer yelling out the contestants names

-Steven spielberg with massive abs with a lunar moon drawn on top is clenching a very very very tiny marble in the shape of a hernia, making it almost impossible to see.
-Bill gates is wearing absolutely nothing except his snake belt around his waist. In his hands, he holds laparoscopic equipment which is firmly lodged in his abdomen.
-Bill gates lets off a mighty roar and strangulates steven spieberg's neck. Its a knock out, Bill wins!

TLDR notes:

(Steven spielberg)= spiegelian fascia
(abs and cresent)= rectus abdominus and semilunaris
(tiny marble in a h shape) = hernia small and hard to detect as it is in between the muscle folds

(Billgates)= richters hernia
(snake belt)= what the hernia looks like
(laparoscopic equipment stuck in abdomen)= laparoscopy as a risk factor
(strangling)= richters henia's potential to strangulate and hence be dangerous

Step by step guide to studying Question 2

2)General anatomy of the area, including:
2a)Inguinal canal Vs Inguinal ligament,
2b)deep ing ring vs superficial ring,
2c) ing canal borders,
2d) ing canal contents (Male vs female)

Just looking at question 2, I already know some of the answers to 2a and 2d.
2a) inguinal ligament = ASIS to pubic tubercle
2d) Male = ilioinguinal nerve+ spermatic cord(testicular nerve, artery, vein, vas deference, pampiniform plexus, lymphatics), female = ilioinguinal nerve and round ligament

I also know the surface markings of the deep inguinal ring(midpoint of inguinal ligament) vs the femoral artery(mid inguinal point= 1/2 ASIS and PS)

Things I need to remember:

During embrological developmet, The inguinal canal is the pathway by which the testes are able to leave the abdominal cavity and enter the scrotum. The structure that pulls the testes and ovaries down is known as the gubernaculum(which icidentally becomes the round ligament in females). During testicular descent, the peritoneum outpockets to form the processus vaginalis, which usually degenerates after birth. Non degeneration can cause hydroceles and indirect hernias.

Deep ring(entrance of inguinal canal) = Midpoint of inguinal ligament. lateral to the epigastric vessels. The ring is created by the transversalis fascia,
Superficial ring(exit)= superior and medial to pubic tubercle. It is a triangle shaped opening, formed by the evagination of the external oblique,

Inguinal canal borders:
The anterior wall is formed by the aponeurosis of the external oblique, and reinforced by the internal oblique muscle laterally.
The posterior wall is formed by the transversalis fascia.During periods of increased intra-abdominal pressure, the abdominal viscera are pushed into the inguinal canal. To prevent herniation, the muscles of the anterior and posterior wall contract, and ‘clamp down’ on the canal.
The roof is formed by the transversalis fascia, internal oblique and transversus abdominis.
The floor is formed by the inguinal ligament (a ‘rolled up’ portion of the external oblique aponeurosis) and thickened medially by the lacunar ligament.

2a)"Tunnel"+ Testes descend + gubernaculum, flanked by outpocket peritoneum = processus vaginalis

2b)Deep= (enterance,, transversalis fascia
superficial = (exit, superior and medial to pubic tubercle, external oblique

WHy I left certain things out for 2b: This is because of logic. certain information can be deduced and with some understanding, you don't have to bother memorising everything.
For example, The deep ring is "lateral to the epigastric vessels". That can be deduced using basic medical knowledge. The lateral border of h***elbach's triangle is the epigastric vessels, and h***elbachs triangle is famous for being the site of direct hernias as well as being a relatively midline structure. Hence, it is not difficult to imagine that the deep ring(being1/2 ASIS and PT) would be more lateral compared to the epigastric vessels.

In addition, the superficial ring must be superior and medial to the pubic tubercle as ALL inguinal hernias are at that location as compared to femoral hernias.

Inguinal canal borders:
anterior = external oblique, internal oblique
posterior = transversalis fascia.
When increased intra-abdominal pressure(IOP), anterior + posterior contract, clamp
roof=transversalis fascia, internal oblique and transversus abdominis.
floor= inguinal ligament + lacunar ligament.

Establishing loci:
Pit lords 3rd ability is atrophy aura, which steals damage and makes him take less. atrophy refers to "decay" or "breakdown" especially in the context of muscular "atrophy". This skill just gives me the impression of a spooky graveyard with rotting flesh and ghosts.

2a) The best way to memorize these meaningless bunch of words is understand it first. Basically, The inguinal canal is a tunnel that your testes use when it migrates down from your abdomen to your scrotum. The gubernaculum is simply a piece of "string" which pulls the testes down via the bottom end of the testes. Next to the inguinal canal is something known as the procesus vaginalis which is a fold of the peritoneum(a sac that encompasses the abdominal cavity)

2a) Image combined with atrophy aura

It is a spooky graveyard and You(Me) are completely naked with your balls(testes) swinging around in the spooky chilly wind. You tunnel(tunnel) in the ground because it is warmer and you distinctly remember tunneling past some dead bodies. Attached to your balls and hence lynching you in the ground and hurting your neck is an Uber cab with numeous G strings attached to it (Gubernaculum). You suddenly come to a stop when you smash into a gigantic vagina(processus vaginalis) and you slowly sink into the folds(peritoneal folds) of the vagina's labia.

Okay listen up guys, I will be sharing a rather important memory technique now that not many people use. The reason why many people don't use it is because it is rather complicated and requires unnecessary additional steps. Nevertheless, it is a useful study technique because it helps with linking topics together.

The idea behind this technique is very much like inception. A roman room within a roman room instead of a dream within a dream. Why do this instead of using different rooms? The reasons why is many fold

1) Using multiple methods to memorise something (eg. switching from character based to location based) is better for memorising something long term because it makes things unique. Most memory athletes only use 1 method because they are interested in speed. As a student, speed is not as important as long term memory over months and months.

2) Using rooms within rooms solidify the relationship of a fact to another fact.

3) When you play dota, you play 1 hero at a time. The more content you stuff into a single hero, the more content you would be able to revise when playing him. When you start having a library of 100+ heroes, it starts making a big difference because you may actually run out of heroes. (note you can revise while you are dead as well by recalling the facts associated with your allied heroes/ enemy heroes)

2b+c) Image combined with Ultimate

Pit lords ultimate is basically mass teleport. And since he is such a fat ***, I would imagine him teleporting to my nearby supermarket with the 5 following points of loci

A) vegetables ( i imagine a vegetable farm)
B) discount section (I imagine that area being a mountain of cash)
C) Fish ( fish is vivid enough to me)
D) Chicken ( I imagine a chaotic chicken coop)
E) Dairy ( I imagine a cow mooing in a pasture)

Note that what i am doing is kind of like a roman room within a roman room within a roman room. Firstly we have used pitlords skill as a method of loci. Second, we have used the supermarket places as a method of loci. Lastly, we transformed the 5 points of loci into new more memorable ones.

A) Vegetable farm will be linked with the deep inguinal ring.

Onion's are tubers that grow deep underground and hence I will make them onion rings ---> deep ring. I imagine a quaint old farm with lots and lots of special onion plants that start of as delicious onion rings(deep ring) right at the (entrance) which is a large wooden door with hay sticking out. The transvertite(transvesalis) farmer greets you at the door with a deep and disturbing "Hi."

Teleport to: Woolsworth super-mart
Veg market=>Onion rings= deep ring
entrance= wooden door with hay sticking out
transversalis= transvestite
Assumed knowledge: Lateral to epigastric vessels and 1/2 inguinal ligament

B) Discount area/pile of cash will be linked with the superficial inguinal ring

Diamond rings are one of the most superficial things ever(I have no idea why people make such a big deal out of a stupid rock) so it will represent the superficial ring.

You spot a room filed with a mountain of cash, but what really catches your eye is this massive diamond ring even the queen will kill for. A large burly guard with the most awkward posture as his hands are firmly stuck in his pockets(external obliques have fibres that are famously described as putting your hand in your pockets as they are arranged in the same direction). He angrily tells you in a thick Australian accent to get out "get out mate" and shoves you towards the exit which is a door lined with 50 Australian dollar notes.

Pile of cash=> diamond ring = superficial ring
guard with hands in pocket shoving to exit= external oblique+ exit
Assumed knowledge= located superior and medial to pubic tubercle

2c) Things to memorise
Inguinal canal borders:
anterior = external oblique, internal oblique
posterior = transversalis fascia.
When increased intra-abdominal pressure(IOP), anterior + posterior contract, clamp
roof=transversalis fascia, internal oblique and transversus abdominis.
floor= inguinal ligament + lacunar ligament.

This looks like alot of things to memorise but it is actually not that much. It can actually be represented into a rather oddly shaped house

2c) borders of the inguinal canal will be linked with a fish
I would draw a huge fish in a shape of a box. The front part(anterior) will be represented by a crisscross pattern (internal and external oblique fibers). The back part(posterior) will have a transverstite trying to have buttsecks with the back of the house which explains why the transversalis must be posterior.

I imagine that after buttsecks from the back end, the transverstite would climb on top (roof = transversialis) rubbing his transverstite abs on top (transversus abdominus) eventually ******* inside you (internal oblique)

The floor does not need a mnemonic as it is obvious that it will be the inguinal ligament.

Fish=>Borders of inguinal canal as it loosely resembles a fish anyway
Anterior= crisscross= int ext oblique
Posterior= transvestite = transversialis
Roof= transverstite + his/her abs+ ******* inside = transversialis, transversus abdominus, int oblique
Assumed knowledge= floor is lacunar ligament+ inguinal ligament

Step by step guide to studying Question 3/4/5/6

3) What is the anatomical difference between an inguinal hernia and a femoral hernia?
4) On examination, what is the difference between an inguinal hernia and a femoral hernia?
5) What is the importance of deciding whether a hernia is inguinal or femoral?
6) what is the difference between incarceration and strangulation

I am doing these 3 questions together because there is not much info to memorise

3)femoral hernias are below and lateral to pubic tubercle (below inguinal ligament). femoral ring/slightly medial to the femoral sheath containing the femoral artery, incarcerates/strangulates frequently. Females

Direct inguinal hernias are above and medial to pubic tubercle (above inguinal ligament), protrude through h***elbachs triangle which is medial to the inferior epigastric vessels. They are due to weakness in the connective tissue in the floor of the inguinal canal. exacerbated mostly by increased IOP. males(because more males have COPD)

Indirect Inguinal hernia= anywhere between deep ring and scrotum (within inguinal canal+ scrotum) both genders

Femoral: dangerous, medial to femoral artery, female(wider pelvis)
Direct: h***elbachs triangle, medial to inferior epigastric vessels, men (COPD)
Indirect: deep ring to scrotum

4) Differentiating femoral and inguinal hernias via physical exam is difficult as their positions can overlap each other. Classically speaking, the stalk of femoral hernias are superior to the inguinal ligament and vice versa. Femoral hernias are also much more likely to be strangulated/incarcerated which gives the signs
-heaviness or dull discomfort in the groin/pain +- worsening with increased IOP.
Ultrasounds are used to confirm the diagnosis in case of uncertainty.

Position(intrinsic knowledge), strangulated/incarcerated= discomfort/pain worsened with coughing. Use ultrasound

5) Femoral hernias are more likely to be incarcerated/ strangulated. femoral hernias are much more likely to have emergency surgeries and urgent elective surgeries rather than watchful waiting

Note* memorised as part of question 3

6). Incarceration means that the hernia is irreducible and cannot be pushed back in, usually because of adhesions. When the hernia is incarcerated it may get more and more oedematous, increasing the risk of strangulation. Strangulation is when there is an element of ischemia and necrosis(death of tissue)

O/E: An incarcerated or strangulated hernia is usually painful to palpation. The patient may also be febrile and the overlying skin may be erythematous. Strangulated hernias may manifest with symptoms of bowel obstruction (nausea, vomiting, abdominal pain, abdominal distension, constipation). Generalized peritonitis typically does not occur as the ischemic or necrotic tissue is trapped within the hernia sac.

(intrinsic knowledge)
Incarcerated= irreducible
Strangulated= ischemia+ necrosis

Need to know:
incarceration--> edema--> strangulation
O/E: SIgns of inflamation(rubor, calor, dolor, tumor etc), Bowel obstruction. Nil peritonitis as necrotic tissue trapped in hernia sac.

3) Chicken coop will be linked to qn 3

Imagine a bustling chicken coop with a hen that stands out because it is a particularly TALL+ long legs (Femoral) Hen(female)with a particularly fat butt with fluffy tail feathers (wider pelvis). The hen is really really angry(dangerous)(reason that females are more likely to be angry and dangerous). Wherever the hen walks a trail of blood follows in the middle(medial to femoral artery)

A particularly direct rooster(men) smoking a cigar(COPD) attempts to calm the hen down (direct inguinal hernia)by wrapping his wings around her back in a triangular like embrace (h***elbachs triangle)

All the remaining chicks (children) line up at attention behind the rooster (deep ring to scrotum) to stay out of trouble.

Notes* Location: chicken coop
(Long legs angry big butt hen)= femoral hernia, dangerous, wide hips, female
(direct rooster with cigar hugging hen's back)= direct hernia, male, COPD, h***elbachs triangle
(chicks lining up behind rooster)= indirect hernia, children, inguinal canal+ testes

4) Cows in a pasture will be used to answer question 4 and 6 together as they are pretty short

Imagine numerous cows in the pasture sitting for an exam in a typical exam setting with the tables and all that arranged just like the inguinal ligament (position). Suddenly, the police broke into the test venue, strangled a cow and sent him to jail(strangulated/incarcerated) and beat him up so bad he was moaning in pain(pain) whilst coughing out blood(coughing). A UFO suddenly appeared in the sky and using their tractor beams, save the cow(U/S)

WIthin the UFO spacecraft they dunked the cow in lots of water(edema) and dried him off with a heater(inflammation) in a rather dirty clogged up toilet(bowel obstruction). Your worried friend Katy Perry(peritonitis)dressed only in a burlap sack is not allowed to visit the cow.

(Cow sitting for exam)= O/E
(neatly arranged tables)= position
(police strangulating and incarcerating cow making him groan in pain and cough)= strangulating and incarcerating= pain increasing on coughing

(UFO)= U/S
(bathing cow)= Edema is the intermediate step of incarceration and strangulation
(heater)= inflammation
dirty clogged up toilet= bowel obstruction
(katy perry in burlap sack not allowed to visit)= nil peritonitis, trapped in sac

Step by step guide to studying Question 7

At this point we have 1 last question (how to do a hernia exam). We have multiple options. We can
1) use another hero as loci
2) use a different method of memorising it altogether
3) continue using the shopping centre

I will pick option 3 as I like to condense as many things into a single hero if it is possible. However, I would pick option 2 if there is way too much information and a new loci is necessary. Option 2 is also a possibility as physical examinations can be considered to be kind of separate from theoretical knowledge.

Establishing Loci.
We just used the supermarket which had these 5 locations completely filled up with information.
1) Veg farm
2) discount area
3) Fish
4) chicken
5) dairy

Next to the supermarket is the shopping mall with the following 10 locations we are going to use

1) Bakery
2) alcohol shop
3) XXL mens clothing
4) Video game store
5) Pharmacy
6) Arcade
7) Tattoo shop
8) Expensive watch shop
9) Hairdresser
10) Big W ( Aussie equivalent of the American walmart)

Here are the steps to doing a hernia examination

Obvious steps like wash hands, get chaperone, general inspection etc not included

1) Inspection --> check for cough impulse
2) Palpation--> Feel the scrotum. If you can get above a scrotal lump, it is a indirect hernia instead of a true scrotal lump
3) Palpation--> feel the groin area. Describe the lump's Site, Size, Shape, Consistency, Contours, Colour, Tenderness, Temperature, +- Trans-illumination
4) Palpation--> feel cough impulse by asking patient to turn head away and compressing lump. If swelling becomes tense and expands, there is a positive cough impulse.
5) reduce the lump to test reducibility
6) Compress the deep inguinal ring and test for cough impulse. If hernia reappears, it is a direct hernia; if not, it is an indirect hernia. WIthout pressure on deep ring, indirect will slide down obliquely; direct will project forwards.
7) Percuss and auscultate lump: this may reveal if bowel is present in hernia
8) Repeat examination lying down if 1-7 negative. Always start on good side first.

Making sense of the steps
Never look at a list and say, oh well lets get on to memorising it. That is dumb and inefficient. Instead, think about how you can make life easier for yourself when you actually memorise the thing. Try to understand the concepts behind the things you have to memorise and break them down and siphon out irrelevant stuff. remember this golden rule

"remove nothing essential and add in nothing superfluous"

On to it. It is quite obvious to me that we have to start by describing the hernia ie describe a lump

A quick search on google nets me a mnemonic of the list of things to look for in a lump

"She Cuts The Fish(SCTF) PER". There are 3 each of the Ss, Cs, Ts and Fs

Site -
Size -
Contour - is the lump well-defined or irregular
Consistency - ?soft/firm/hard
Temperature -
Fluctuance - ?fluid-filled cyst
Fixity - ?is it fixed to the underlying tissue or to the overlying skin
Fields - draining lymph glands in the area
PER - Pulsatile(Is it an aneurysm?), expansile , reducible(Is it a hernia?)

I think it is useful to find mnemonics that other people have came up with online, but there are obviously some glaring weaknesses of an acronym, namely the fact that it lacks any form of location/association necessary for optimum memorization. This list also contains quite a number of irrelevant details. For example, What is the point of "site", you are obviously going to look at the "site" where else are you going to look?

Nevertheless, mnemonics give you a short and sweet list of what you have to know(usually) making it ideal stepping stones.

Lets shorten the list and arrange them in order of importance, as well as group the factors that are obviously linked together

Size -
Contour - is the lump well-defined or irregular
Consistency - ?soft/firm/hard
Pulsatile expansile

Fluctuance - ?fluid-filled cyst
Fields - draining lymph glands in the area
Fixity - ?is it fixed to the underlying tissue or to the overlying skin

Okay why did I group the first bunch of terms together? Well that is because when i read those terms, the first thing that comes to mind is that these are the descriptors of a fricking *****. So yeah here is the image

Question 7 part 1 will be linked to the bakery

Imagine that you are in the bakery with the smell of fresh bread in the morning. Just that this time the bakers decide to have some fun and baked the most lifelike ***** you have ever seen.

The Bread ***** is Gigantic and is over 20 inches long(size). It is colored an angry bright red at the tip and a deep chocolaty brown at the base(color) with a finish so smooth due to glazing that you could almost see your reflection on it(contour). You touch it with both your hands and you are satisfied that it is rock hard(consistency) and you are pleasantly surprised that the bread ***** is slightly warm to touch at body temperature. (temperature) The baker is proud of his cake and tells you that this bread is special as it battery operated. When switched on, the ***** starts pulsating and beating just like the real thing(pulsation)Think throbbing ****. And of course, that ***** has a remote control that makes it erect(expansile) or flaccid(reducible)


Image= battery operated bread ***** at bakery
Size = size of *****
Color= red with chocolate
Contour= smooth like a mirror
Consistency = hard as a rock
Temperature= nice and warm. mmmmmm
Pulsatile = throbbing **** when battery operated
expansile/ reducible= erection + retraction of *****

Question 7 part 2 will be linked to the alcohol shop

In the alcohol shop, all the bottles are somehow broken and liquid is pouring all over the floor(fluctuance/ lymph glands), You see a wierd indian yogi master walking on the glass like a boss (pain/tenderness). The reason why he is doing this is because the light bulb in the middle of the shop is broken(transilluminable) and he has to fix it because it is npot properly attached to the ceiling (fixity)

Notes* Alcohol shop with broken bottles
Fluctuance+ lynph nodes = broken bottles leaking
Tenderness = crazy yogi master walking on broken glass
Transilluminable= broken lightbulb
Fixity = need to fix loose light bulb

Question 7 part 3

Understanding the steps is critical to reducing your workload.

Basically these 8 steps can be shortened considerably

1) Observe= Stand up, cough impulse. describe the lump.
2) palpate= scrotum. feel above lump
3) palpate= groin. describe whats left to describe of the lump. ask pt to cough again and turn head away.(probably so he does not cough in your face)
4) Compress the deep ring and ask pt to cough
Note* test reducibility(unnecessary as it is already part of describing the lump!)
5) percuss for bowels
6) repeat lying down

Lets link the remaining locations quickly

Note* there is no need to remember the *describe the lump* in the remaining steps as it is already memorized. just remember to mention it at the exams right at the start.

qn7 part3: link to XXL mens clothing

At the XXL clothes store, you look from a distance(observe) a couple of fat guys hanging around there standing up and coughing violently with a cigarette still in their mouths(cough impulse)

Link to video game store
At the video game store, you see the patrons grabbing their balls and groin and looking sideways towards you and coughing.

Link to the pharmacy
You see a huge wrestling ring in the middle of the pharmacy made up of a wall of pills. In the middle there is a large drum and the wrestlers are using the drum creatively to wrestle each other. The bout ends with both of them lying down in the middle of the ring

XXL store
men standing and coughing violently= stand up and cough

Video game store
patrons grabbing their balls and groin and looking sideways towards you and coughing= self explanatory

Wrestling ring= deep ring
Drums= percuss for bowels
Lying on the ground= repeat exam lying down

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