Massive splenomegaly common causes

* Chronic myeloid leukaemia
* Myelofibrosis
* Lymphoma
* Thalassaemia major or intermedia
* Gaucher's disease
* Leishmaniasis
* Tropical splenomegaly

To remember reflexes and the nerves

• One, two, buckle my shoe - ankle jerk : S1-2
• Three, four, kick at the door - patellar tendon : L3-4
• Five, six, pick up sticks - biceps/brachioradialis : C5-6
• Seven, eight, close the gate - triceps: C7-8

How Angiotensin Converting Enzyme (ACE) Inhibitors cause increase in bradykinin

• Angiotensin Converting Enzyme (ACE) degrades bradykinin, not only converting angiotensin I to angiotensin II
• So, when ACE inhibitors present, bradykinin is not broken down
• There will be high level of bradykinin
• Causing side effect such as chronic dry cough