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Internam medicine mnemonics - part II
[b]NEPHROTIC SYNDROME (NS) is characterized by the following: [/b]
N = Na + water retention
This occurs due to several factors, including compensatory secretion of aldosterone in response to hypovolemia-mediated release of ADH. E = Edema
Due to hypoproteinemia + Na, water retention. Edema is soft, pitting and starts in the periorbital region. P = Proteinuria >3.5gm/1.74sq. ml/24hrs H = Hypertension + hyperlipidemia (due to increased lipoprotein synthesis in liver, abnormal transport of circulating lipoproteins, decreased catabolism.) R = Renal vein thrombosis O = "Oval fat bodies" in the urine. Lipiduria follows hyperlipidemia. Albumin as well as lipoproteins are lost. Lipoproteins are reabsorbed by tubular epithelial cells and they shed along with degenerated cells- this appears as "oval fat bodies" in urine. T = Thrombotic + thromboembolic complications owing to loss of anticoagulant factors (eg. anti-thrombin III ) I = Infection. These patients are prone to infection, especially with staphylococci and pneumococci. Vulnerability is due to loss of immunoglobulins. C = hyperCoagulable state [b]Henoch-Schonlein Purpura[/b]
"JARS"
J - Joints
A - Abdominal pain
R - Renal
S - Skin [b]Causes of hematuria [/b]? Use the mnemonic SITTT as an aid in evaluating the cause of hematuria: S: Stone
I: Infection
T: Trauma
T: Tumor
T: Tuberculosis Causes of secondary nephrotic syndrome ie. not of direct renal origin are DAVID - Diabetes mellitus, Amyloidosis, Vasculitis, Infections, Drugs. Causes of acute and reversible forms of urinary incontinence The following mnemonic aids in remembering the causes of acute and reversible forms of urinary incontinence - DRIP D: Delirium
R: Restricted mobility, retention
I: Infection, inflammation, impaction (fecal)
P: Polyuria, pharmaceuticals [b]Hereditary cystic disorders: Polycystic kidney disease[/b] Autosomal dominant polycystic kidney disease (ADPKD) is associated with cysts in the kidneys and, in many cases, in the brain (berry aneurysms), liver, spleen, pancreas, and lungs. ??Halley Berry AKA Dorothy (Dandridge) Portrayed Carmen Jones.?? Halley ?Hematuria: Gross and microscopic
Berry -Berry aneurysms [b]AKA ?ADPKD[/b] D-Dominant (autosomal) inheritance
O-Obstruction of the urinary tract by stones, blood clots R-Renal failure
O-Oxalate: calcium oxalate and uric acid stones
T-renal Tubular defects
H-Hemorrhagic cysts
Y-Year 1 - Most cases are diagnosed in the first year of life, presenting as bilateral abdominal masses. Portrayed ?Polycystic: continued enlargement of the cysts often leads to progressive renal failure. Carmen ?CT scanning: Enlarged kidneys with multiple bilateral cysts are diagnosed using ultrasound, IVP,
or CT scanning.
Jones - Juvenile nephronophthisis (JN) and medullary cystic disease (MCD) are in the DDx. -Cardiac valvular disorders: Mostly mitral valve prolapse (MVP) and aortic regurgitation -Salt-wasting nephropathy, renal tubular acidosis (RTA) -Chronic flank pain due to the mass effect of the enlarged kidneys Lusty Carmen Jones powdered her nose, using her Bivalve [MVP] mirror compact, ?? -then she slowly raised her Salt-rimmed [Salt-wasting nephropathy] MargaRiTA [RTA], and seductively
placed her other hand on her Hip [Flank pain]. -Hyperchloremic acidosis
-Salt-wasting nephropathy causing hyponatremia It was said that Dorothy was not allowed to swim in the hotels Chlorinated pool [Hyperchloremic acidosis].
When she defiantly swam in the pool, they Drained it [Salt-wasting nephropathy, Hyponatremia]. -Hypertension
-End-stage renal disease (ESRD) Dorothy was forced to enter through the back door, even while she was contracted to sing under The Big
Tent [Hypertension].
Dorothy was only 41 when she was found DEAD [ESRD]. Review: Dx: Positive family history (autosomal dominant inheritance)
Gross and microscopic hematuria
Ultrasound, IVP, or CT scanning detect the enlarged kidneys with multiple bilateral cysts [b]Renal Pathology Buzz words[/b]
Lupus = wire LOOP lesion (LUPUS=LOOP) goodPASTURE = a pasture is FLAT so is the immunoflouresence for GP Membraneous GN = spike and DOME appearance (think membrane = dome)
(held up by spikes) Membranoproliferative GN = M P GN = Tram Track
think of MP's (military police riding on Trams) Post streptococcal GN= Lumpy Bumpy
think Strep aerobics
Lumpy people Bumping
around doing aerobics WBC Count
"Never Let Mom Eat Beans" and "60, 30, 6, 3, 1"
? Neutrophils 60%
? Lymphocytes 30%
? Monocytes 6%
? Eosinophils 3%
? Basophils 1% Hem - PT, PTT: To remember the intrinsic and extrinsic pathways in relation to what blood test is affected: PiTT (I for Intrinsic pathway) - PiTTsburgh
PeT (E for Extrinsic pathway) Vitamin K-dependent proteins and warfarin sodium [by Sung Kim and S. Levine, MD, PhD.] Warfarin sodium is a vitamin K antagonist. -Vitamin K-dependent proteins C and S.
-Vitamin K-dependent clotting factors II, VII, IX, and X of the extrinsic pathway. --> The Korean [vitamin K] War [Warfarin] was fought Outdoors [Extrinsic
--> pathway]. The American PT boats [PT, Protime, or prothrombin time],
--> whose access had been limited
by the rough Seas [protein C], quickly sent out SOS [protein S] messages. Microcytic Anemia
"TICS"-
Thalasemia
Iron deficiency
Chronic disease
Sideroblastic anemia Submitted by Jeff Rodgerson M.D.
HCMC Medical Center [b]Eosinophilia
"NAACP" [/b] N - Neoplasm
A - Allergy
A - Addison's
C - Cirrhosis, CVD
P - Parasite (visceral larva migrans), Periarteritis nodosa
Submitted by Tag Filley, M.D. Thalassemia major is the most Severe ?-thalassemia [B-Beta-Bad]. -Major B-A-D M-A-F-I-A guys have the typical gangster appearance:
Short [Microcytic hypochromic anemia] and
Ugly [distortion of facial, skull, and long bones] B-Basophilic stippling
A-Anemia, Anisocytosis
D-Deferoxamine M?MCV is low
A-HbA is decreased
F-HbF is increased
I-Ineffective erythropoiesis
A?HbA2 is increased Cooley's anemia (beta-thalassemia major) is the homozygous state. -The key is Denton A. Cooley, M.D., Texas Heart Institute (THI). D-Deferoxamine therapy to prevent hemochromatosis
A-Anemia - In beta-thalassemia major or intermedia, anemia is due to a combination of ineffective erythropoiesis
and hemolysis of circulating cells. C-Congestive heart failure is a cause of death in the first years of life if the patient is not transfused. M-MCV is low; Microcytic hypochromic anemia
D-Diagnosis, prenatal T-Tower skull (also frontal bossing, chipmunk facies, and distortion of long bones) H-Hemolytic anemia with Hepatosplenomegaly in the first year of infant life I-Intermedia - Beta-thalassemia intermedia presents with abnormalities similar to those of thalassemia major. Increased susceptibility to infections Peripheral blood smear: Basophilic stippling
Helmet cells
Nucleated target cells
Anisocytosis (RBCs of different size/volume) X-ray: Hair-on-end skull Serum hemoglobin electrophoresis: HbA is decreased.
HbA2 is increased.
HbF is increased --> Dr. Cooley performed Major surgery [thalassemia Major] as a
--> Cardiothoracic surgeon [Cardiac failure] live
on the Internet [Infections]. --> His skilled hands can perform Microsurgery [Microcytic hypochromic
--> anemia] on Fetuses [HbF]. --> His surgical cap [Helmet cells] fit loosely over his Crew cut
--> [Hair-on-end skull]. --> He proceeded to make an incision along the Blue Stippled line
--> [Basophilic Stippling] drawn on the skin. --> Dr. Cooley's Target [Target cells] academic score had always been an
--> A+ [HbA2 is increased]. --> He would Not accept a simple A [HbA is decreased]. --> The surgical staff is a close knit community, like a B-A-D M-A-F-I-A
--> (see below), quick to dispose of weak,
Ineffective [Ineffective erythropoiesis] residency candidates. [b]Disseminated intravascular coagulation (DIC) D-I-S-S-E-M-I-N-A-T-E-D[/b]
D-Dx: D dimer
I-Immune complexes
S-Snakebite, shock, heatstroke
S-SLE
E-Eclampsia, HELLP syndrome
M-Massive tissue damage
I-Infections: viral and bacterial
N-Neoplasms
A-Acute promyelocytic leukemia
T-Tumor products: Tissue Factor (TF) and TF-like factors released by carcinomas of pancreas, prostate, lung,
colon, stomach
E-Endotoxins (bacterial)
D-Dead fetus (retained) Characteristic features of multiple myeloma on X-ray are ABCDE - Asymmetry, Border irregular, Colour irregular, Diameter usually > 0.5cm, Elevation irregular. Chronic lymphocytic leukemia (CLL) is a monoclonal malignancy, usually of B lymphocytes. -Incidence: CLL is the most common adult leukemia in the United States.
Males>Females
50-70 years of age Songwriter Phil CoLLins [CLL] is Male and probably over 50 years of age. He recently won an
Oscar for his "Tarzan" song. Clinical and diagnosis Lymphocytosis >15,000/mm3
Generalized lymphadenopathy Tarzan can spring from Limb [Lymphocytosis] to Limb [Lymphadenopathy] above the tree
tops?? Splenomegaly, hepatomegaly
Low serum immunoglobulins (immunosuppression) --> where the Splendid [Splenomegaly] Moonlight [imMunosuppression]
--> streams through the
branches. Diffuse bone marrow infiltration and replacement of cellular elements cause:
Anemia
Thrombocytopenia
Granulocytopenia --> Walt Disney Pictures produced the Animated Animal [Anemia] adventure
--> "Tarzan". --> The "Tarzan" [Thrombocytopenia] song earned CoLLins an Oscar [Osteo,
--> bone marrow failure]
award for the best original song. --> Tarzan had Little need for Plates [Platelets <100,000/??L] in the
--> jungle. --> Phil CoLLins is a Grammy [Granulocytopenia] Award-winning singer and
--> songwriter. Occasionally extravascular hemolysis: warm-antibody autoimmune hemolytic anemia (AHA) --> An African jungle [Autoimmune extravascular] APE [AHA] had Warmly
--> [Warm-antibody]
adopted baby Tarzan. Differential diagnosis
Malignant lymphoma
Infectious mononucleosis --> Tarzan is Lord [Lymphoma] of the Jungle and friend of the Monkeys
--> [Mononucleosis]. Phil CoLLins was born in London [Lymphoma]. Treatment
Chlorambucil (an alkylating agent), with or without prednisone
Fludarabine --> Some may imagine a Ram [ChloRambucil] scrambling about, but others
--> will?? --> recall that Clayton [Chlorambucil] is the villainous jungle guide
--> who was hired by
Professor [Prednisone] Porter, not knowing that?? --> ??Clayton [Chlorambucil] had his captured Prey [Prednisone]
--> immediately Flown
[Fludarabine] out for profit.
N = Na + water retention
This occurs due to several factors, including compensatory secretion of aldosterone in response to hypovolemia-mediated release of ADH. E = Edema
Due to hypoproteinemia + Na, water retention. Edema is soft, pitting and starts in the periorbital region. P = Proteinuria >3.5gm/1.74sq. ml/24hrs H = Hypertension + hyperlipidemia (due to increased lipoprotein synthesis in liver, abnormal transport of circulating lipoproteins, decreased catabolism.) R = Renal vein thrombosis O = "Oval fat bodies" in the urine. Lipiduria follows hyperlipidemia. Albumin as well as lipoproteins are lost. Lipoproteins are reabsorbed by tubular epithelial cells and they shed along with degenerated cells- this appears as "oval fat bodies" in urine. T = Thrombotic + thromboembolic complications owing to loss of anticoagulant factors (eg. anti-thrombin III ) I = Infection. These patients are prone to infection, especially with staphylococci and pneumococci. Vulnerability is due to loss of immunoglobulins. C = hyperCoagulable state [b]Henoch-Schonlein Purpura[/b]
"JARS"
J - Joints
A - Abdominal pain
R - Renal
S - Skin [b]Causes of hematuria [/b]? Use the mnemonic SITTT as an aid in evaluating the cause of hematuria: S: Stone
I: Infection
T: Trauma
T: Tumor
T: Tuberculosis Causes of secondary nephrotic syndrome ie. not of direct renal origin are DAVID - Diabetes mellitus, Amyloidosis, Vasculitis, Infections, Drugs. Causes of acute and reversible forms of urinary incontinence The following mnemonic aids in remembering the causes of acute and reversible forms of urinary incontinence - DRIP D: Delirium
R: Restricted mobility, retention
I: Infection, inflammation, impaction (fecal)
P: Polyuria, pharmaceuticals [b]Hereditary cystic disorders: Polycystic kidney disease[/b] Autosomal dominant polycystic kidney disease (ADPKD) is associated with cysts in the kidneys and, in many cases, in the brain (berry aneurysms), liver, spleen, pancreas, and lungs. ??Halley Berry AKA Dorothy (Dandridge) Portrayed Carmen Jones.?? Halley ?Hematuria: Gross and microscopic
Berry -Berry aneurysms [b]AKA ?ADPKD[/b] D-Dominant (autosomal) inheritance
O-Obstruction of the urinary tract by stones, blood clots R-Renal failure
O-Oxalate: calcium oxalate and uric acid stones
T-renal Tubular defects
H-Hemorrhagic cysts
Y-Year 1 - Most cases are diagnosed in the first year of life, presenting as bilateral abdominal masses. Portrayed ?Polycystic: continued enlargement of the cysts often leads to progressive renal failure. Carmen ?CT scanning: Enlarged kidneys with multiple bilateral cysts are diagnosed using ultrasound, IVP,
or CT scanning.
Jones - Juvenile nephronophthisis (JN) and medullary cystic disease (MCD) are in the DDx. -Cardiac valvular disorders: Mostly mitral valve prolapse (MVP) and aortic regurgitation -Salt-wasting nephropathy, renal tubular acidosis (RTA) -Chronic flank pain due to the mass effect of the enlarged kidneys Lusty Carmen Jones powdered her nose, using her Bivalve [MVP] mirror compact, ?? -then she slowly raised her Salt-rimmed [Salt-wasting nephropathy] MargaRiTA [RTA], and seductively
placed her other hand on her Hip [Flank pain]. -Hyperchloremic acidosis
-Salt-wasting nephropathy causing hyponatremia It was said that Dorothy was not allowed to swim in the hotels Chlorinated pool [Hyperchloremic acidosis].
When she defiantly swam in the pool, they Drained it [Salt-wasting nephropathy, Hyponatremia]. -Hypertension
-End-stage renal disease (ESRD) Dorothy was forced to enter through the back door, even while she was contracted to sing under The Big
Tent [Hypertension].
Dorothy was only 41 when she was found DEAD [ESRD]. Review: Dx: Positive family history (autosomal dominant inheritance)
Gross and microscopic hematuria
Ultrasound, IVP, or CT scanning detect the enlarged kidneys with multiple bilateral cysts [b]Renal Pathology Buzz words[/b]
Lupus = wire LOOP lesion (LUPUS=LOOP) goodPASTURE = a pasture is FLAT so is the immunoflouresence for GP Membraneous GN = spike and DOME appearance (think membrane = dome)
(held up by spikes) Membranoproliferative GN = M P GN = Tram Track
think of MP's (military police riding on Trams) Post streptococcal GN= Lumpy Bumpy
think Strep aerobics
Lumpy people Bumping
around doing aerobics WBC Count
"Never Let Mom Eat Beans" and "60, 30, 6, 3, 1"
? Neutrophils 60%
? Lymphocytes 30%
? Monocytes 6%
? Eosinophils 3%
? Basophils 1% Hem - PT, PTT: To remember the intrinsic and extrinsic pathways in relation to what blood test is affected: PiTT (I for Intrinsic pathway) - PiTTsburgh
PeT (E for Extrinsic pathway) Vitamin K-dependent proteins and warfarin sodium [by Sung Kim and S. Levine, MD, PhD.] Warfarin sodium is a vitamin K antagonist. -Vitamin K-dependent proteins C and S.
-Vitamin K-dependent clotting factors II, VII, IX, and X of the extrinsic pathway. --> The Korean [vitamin K] War [Warfarin] was fought Outdoors [Extrinsic
--> pathway]. The American PT boats [PT, Protime, or prothrombin time],
--> whose access had been limited
by the rough Seas [protein C], quickly sent out SOS [protein S] messages. Microcytic Anemia
"TICS"-
Thalasemia
Iron deficiency
Chronic disease
Sideroblastic anemia Submitted by Jeff Rodgerson M.D.
HCMC Medical Center [b]Eosinophilia
"NAACP" [/b] N - Neoplasm
A - Allergy
A - Addison's
C - Cirrhosis, CVD
P - Parasite (visceral larva migrans), Periarteritis nodosa
Submitted by Tag Filley, M.D. Thalassemia major is the most Severe ?-thalassemia [B-Beta-Bad]. -Major B-A-D M-A-F-I-A guys have the typical gangster appearance:
Short [Microcytic hypochromic anemia] and
Ugly [distortion of facial, skull, and long bones] B-Basophilic stippling
A-Anemia, Anisocytosis
D-Deferoxamine M?MCV is low
A-HbA is decreased
F-HbF is increased
I-Ineffective erythropoiesis
A?HbA2 is increased Cooley's anemia (beta-thalassemia major) is the homozygous state. -The key is Denton A. Cooley, M.D., Texas Heart Institute (THI). D-Deferoxamine therapy to prevent hemochromatosis
A-Anemia - In beta-thalassemia major or intermedia, anemia is due to a combination of ineffective erythropoiesis
and hemolysis of circulating cells. C-Congestive heart failure is a cause of death in the first years of life if the patient is not transfused. M-MCV is low; Microcytic hypochromic anemia
D-Diagnosis, prenatal T-Tower skull (also frontal bossing, chipmunk facies, and distortion of long bones) H-Hemolytic anemia with Hepatosplenomegaly in the first year of infant life I-Intermedia - Beta-thalassemia intermedia presents with abnormalities similar to those of thalassemia major. Increased susceptibility to infections Peripheral blood smear: Basophilic stippling
Helmet cells
Nucleated target cells
Anisocytosis (RBCs of different size/volume) X-ray: Hair-on-end skull Serum hemoglobin electrophoresis: HbA is decreased.
HbA2 is increased.
HbF is increased --> Dr. Cooley performed Major surgery [thalassemia Major] as a
--> Cardiothoracic surgeon [Cardiac failure] live
on the Internet [Infections]. --> His skilled hands can perform Microsurgery [Microcytic hypochromic
--> anemia] on Fetuses [HbF]. --> His surgical cap [Helmet cells] fit loosely over his Crew cut
--> [Hair-on-end skull]. --> He proceeded to make an incision along the Blue Stippled line
--> [Basophilic Stippling] drawn on the skin. --> Dr. Cooley's Target [Target cells] academic score had always been an
--> A+ [HbA2 is increased]. --> He would Not accept a simple A [HbA is decreased]. --> The surgical staff is a close knit community, like a B-A-D M-A-F-I-A
--> (see below), quick to dispose of weak,
Ineffective [Ineffective erythropoiesis] residency candidates. [b]Disseminated intravascular coagulation (DIC) D-I-S-S-E-M-I-N-A-T-E-D[/b]
D-Dx: D dimer
I-Immune complexes
S-Snakebite, shock, heatstroke
S-SLE
E-Eclampsia, HELLP syndrome
M-Massive tissue damage
I-Infections: viral and bacterial
N-Neoplasms
A-Acute promyelocytic leukemia
T-Tumor products: Tissue Factor (TF) and TF-like factors released by carcinomas of pancreas, prostate, lung,
colon, stomach
E-Endotoxins (bacterial)
D-Dead fetus (retained) Characteristic features of multiple myeloma on X-ray are ABCDE - Asymmetry, Border irregular, Colour irregular, Diameter usually > 0.5cm, Elevation irregular. Chronic lymphocytic leukemia (CLL) is a monoclonal malignancy, usually of B lymphocytes. -Incidence: CLL is the most common adult leukemia in the United States.
Males>Females
50-70 years of age Songwriter Phil CoLLins [CLL] is Male and probably over 50 years of age. He recently won an
Oscar for his "Tarzan" song. Clinical and diagnosis Lymphocytosis >15,000/mm3
Generalized lymphadenopathy Tarzan can spring from Limb [Lymphocytosis] to Limb [Lymphadenopathy] above the tree
tops?? Splenomegaly, hepatomegaly
Low serum immunoglobulins (immunosuppression) --> where the Splendid [Splenomegaly] Moonlight [imMunosuppression]
--> streams through the
branches. Diffuse bone marrow infiltration and replacement of cellular elements cause:
Anemia
Thrombocytopenia
Granulocytopenia --> Walt Disney Pictures produced the Animated Animal [Anemia] adventure
--> "Tarzan". --> The "Tarzan" [Thrombocytopenia] song earned CoLLins an Oscar [Osteo,
--> bone marrow failure]
award for the best original song. --> Tarzan had Little need for Plates [Platelets <100,000/??L] in the
--> jungle. --> Phil CoLLins is a Grammy [Granulocytopenia] Award-winning singer and
--> songwriter. Occasionally extravascular hemolysis: warm-antibody autoimmune hemolytic anemia (AHA) --> An African jungle [Autoimmune extravascular] APE [AHA] had Warmly
--> [Warm-antibody]
adopted baby Tarzan. Differential diagnosis
Malignant lymphoma
Infectious mononucleosis --> Tarzan is Lord [Lymphoma] of the Jungle and friend of the Monkeys
--> [Mononucleosis]. Phil CoLLins was born in London [Lymphoma]. Treatment
Chlorambucil (an alkylating agent), with or without prednisone
Fludarabine --> Some may imagine a Ram [ChloRambucil] scrambling about, but others
--> will?? --> recall that Clayton [Chlorambucil] is the villainous jungle guide
--> who was hired by
Professor [Prednisone] Porter, not knowing that?? --> ??Clayton [Chlorambucil] had his captured Prey [Prednisone]
--> immediately Flown
[Fludarabine] out for profit.
Jews during their childhood years (6-12 years of age). -The key is Bette [aBeta] Midler, who is Jewish [Ashkenazi Jews] by birth, but hardly shy or
Recessive. -Clinical: Lack of intestinal apolipoprotein B causes mild malabsorption (notably of fat-soluble
vitamins A, D, E, K), steatorrhea, and low serum chylomicrons, VLDL, IDL, and LDL. - Did you know that Bette is computer-savvy? Know that she created her own web page
on a PC, and Not on an Apple [No Apolipoprotein-B] computer. Progressive neuromuscular disease of the peripheral nervous system (PNS) and of the
cerebellum (ataxia of gait, trunk, and limbs). - Bette wanted to be featured on serious PBS [PNS] television, but instead her trash
with flash persona was interviewed for E! Celebrity [Cerebellum] Profile. - Bette paid heavy Taxes [aTaxia] after starring in "That Old Feeling" [sensory ataxia] with
Dennis Farina. - The concert tour: As the tail-wagging mermaid, Bette motored around the stage in a
Wheelchair [muscle weakness]. Retinitis pigmentosa
-Then she donned her mermaid Goggles [retinitis pigmentosa] and grinned. -Diagnosis: Ataxia plus acanthocytes in peripheral blood smear. The low cholesterol gives rise to
deformed or spiky red blood cells called acanthocytes.
Low apolipoprotein B, low vitamin E
Low plasma triglyceride (TG) and cholesterol levels - The Jewish Cantor [aCanthocytosis] disapproved of the bawdy stiletto Spike [Spiky
RBC] heels she wore to holy day services. Small bowel biopsy: Foamy epithelial cells and lacy villus tips.
- The mermaid character was set in a Foamy [epithelial cells] sea backdrop.
- Under her Lacy [Lacy villus tips] mermaid costume, Bette had to wear a tightly laced
corset. She was still No Twiggy [low TGs]. -Treatment: Low fat diet, fat-soluble vitamins such as vitamins A and E.
- Bette tried to lose weight on a Low Fat Diet in preparation for her A&E [vitamins A and
E] interview. [b]Radiopaque Ingestants[/b]
"Chipes"
C - Cocaine condoms/ chloral hydrate/ calcium
H - Heavy metals
I - Iron/ iodides
P - Psychotropics (TCA, phenothiazines)
E - Enteric coated/BA
S - Solvents (CCl4) [b]Drugs that can go into an ET tube[/b] "lane"
L - lidocaine
A - atropine
N - naloxone
E - epi
Some like NAVEL, which includes Valium. Others have commented that valium should not go in an ET tube. [b]
History taking in EMS[/b] "sample"
S - signs/symptoms
A - allergies
M - medications
P - past medical history
L - last oral intake
E - events leading to injury or illness [b]Pain scale: "OPQRST"[/b] O - onset
P - provocation
Q - quality
R - radiation
S - severity
T - time [b]Pain Scale (Revisited)
PQRSTAPPP [/b]
P - palliates/provokes
Q - quality
R - region/radiation
S - severity (on a 1-10 scale)
T - timing (onset, frequency, duration)
A - associated symptoms
P - prior
P - persists
P - progression (stable, better, worse)
Submitted by Omar A. Blanco [b]More on Pain Evaluation[/b]
LOCI" (Latin for places) and the "Daughters of the American Revolution"
L - Location
O- Onset
C- Character
I- Intensity
D- Duration
A- Aggravation
A- Alleviation
A - Association
R - Radiation [b]One More Pain Mnemonic [/b]
P - period of pain
A - area of pain
I - intensity of pain
N - nullify ( what makes pain go away, if any)
Submitted by Greg Van Hook Concretions:
[b]"Big Mess" [/b]
B - Barbituates
I - Iron
G - Glutethemide
M - Meprobamate
E - Extended release theophylline
SS - Salicylates X linked
? Bleeder, Blind, Becker and Duch, B cell
? others : G6PD,NDI,SCID,CGD Enjoy reading this, really good stuff
You can do it, we can help!
Prab, Moderator
-Slowly dying
-Alcohol
-Brain injury [b]Cerebrovascular I-N-F-A-R-C-T-S [/b] I-Infections: septic heart valve vegetations
N-Neoplasms; Nonbacterial thrombotic endocarditis
F-Fracture of the long bone
A-Atherosclerosis, Atrial fibrillation-related emboli
R-Reperfusion -> infarct -> hemorrhage
C-Carotid atheromas or mural thrombi
T-Thrombotic occlusions
S-Sylvan fissure: MCA is a particularly common site. Lacunar infarct: "Lacunar" from the Latin for G-A-P or- D-I-S-P-A-R-I-T-Y G-deep Gray matter: basal ganglia
A-Atherosclerosis
P-hyPertension D-Dysarthria and a contralateral clumsy hand or arm due to infarction in the base of the pons or in the genu
of the internal capsule. (20%)
I-Internal Capsule: Lacunae in the posterior limb of the Internal capsule may cause pure motor hemiplegia
involving the face, arm, leg, foot. (60%)
S-Subcortical, capsular, or thalamic lacunae
P-Pontine lesions
A-Ataxic hemiparesis due to an infarct in the base of the pons
R-Rare: Lacunae in the anterior limb of the Internal capsule may cause severe dysarthria with facial weakness.
I-Ipsilateral ataxia (arm/leg) with leg weakness: Pontine lesion (rare)
T-Thalamus: Lacunae in the Thalamus may cause pure sensory stroke (10%)
y-V-Ventrolateral Thalamic lacunae Anterior cerebral artery (A*C*A) occlusion: *C*-Contralateral Crural (leg) monoplegia
*C*-Crest of Cerebral hemispheres and medial hemispheric walls represent the leg area of the motor strip Middle cerebral artery (MCA) occlusion: "Difficulty with A-B-Cs in M-C-A" A-Apraxia
B-Blindness in corresponding half of the visual field (contralateral homonymous hemianopsia)
C-Contralateral Clumsiness of arm, face. -- Leg is somewhat spared. M-Memorization difficulties
C-Calculation difficulties
A-Aphasia with language-dominant hemispheral involvement. Posterior cerebral artery (PCA) occlusion: P-O-S-T P-Proximal fling movements
O-Occipital lobe infarction results in contralateral homonymous hemianopsia which may be complete
S-Speech and Spelling maintained, but unable to read fluently
T-Thalamic syndrome A well-known mnemonic regarding occlusion of the vertebral-basilar circulation: 4D -Dizziness
-Diplopia
-Dysarthria
-Dysphagia Types of Stroke Stroke "H-I-T" you! H-Hemorrhagic
I-Ischemic
T-TIA (Transient Ischemia Attack) T.I.A (Transient Ischemic attack) Patients often describe it as a shade being pulled over their eyes: S-H-A-D-E-D S-Sensory loss; TIA may herald a stroke
H-Hypertension, Hyperlipidemia
A-Amaurosis fugax (transient monocular blindness)
D-DDx: seizures, neoplasms, migraine, vertigo
E-Extrinsic factor is monitored for warfarin administration; E-Endarterectomy
D-Diabetes Root values of reflexes are 1,2,3,4,5,6,7,8 - S1-2 ankle, L3-4 knee, C5-6 biceps/supinator, C7-8 triceps. [b]Argyle Robertson Pupil [/b]? Accomodation Reflex Present - Pupillary Reflex Absent. [b]Neurosyphilis [/b]
-Symptomatic Neurosyphilis: The small, irregular Argyll Robertson pupil reacts to accommodation but
not to light.
-Tabes dorsalis:
Argyl-Robertson Pupil (ARP) in syphlis - Accomodation Reflex Present (ARP)
but the light reflex is absent, so ARP=ARP.
-General paresis: P-A-R-E-S-I-S*
P-Personality
A-Affect
R-Reflexes are hyperactive
E-Eye: Argyll Robertson pupils
S-Sensorium: illusions, delusions, hallucinations
I-Intellect: decrease in recent memory, orientation, calculations
S-Speech [b]
Pattern of Weakness in UMN lesions [/b]? FLUE weakness FUELs Contractures
? F=Flexion,L=Lower Limb,U=Upper Limb E= Extensors [b]Normal Pressure Hydrocephalus [/b]? Demented (Memory Loss)
? Dribbles (Urinary Incontinence)
? Disbalanced (Gait disorder) [b]TRAP to identify parkinson's disease [/b]
? Tremor at rest (pill-rolling tremor)
? Rigidity
? Akinesia
? Posture typical of a Parkinson's patient
You can do it, we can help!
Prab, Moderator
"AEIOU TIPS"
A - Alcohol/drugs
E - Endocrine
I - Insulin
O - Opiates
U - Uremia
T - Toxins/trauma
I - Infections
P - Psych/porhyria
S - SAH, shock, stroke, seizure, space occupying lesion MIDAS : States to exclude as cause of coma.
? Meningitis
? Intoxication
? Diabetes
? Air - respiratory failure
? Subdural or subarachnoid hemorrhage. [b]Level of consciousness[/b]
"AVPU"
A - alert
V - resonds to verbal stimuli
P - responds to painful stimuli
U - unconscious [b]Vertebral/Basilar Ischemia
4Ds [/b]
dizziness (nystagmus)
diplopia (skew deviation)
dysarthria
dysphagia
Submitted by: Ronald H. Miller, OD, The Ohio State University Cerebellar lesions lead to VANISHeD - Vertigo, Ataxia, Nystagmus, Intention tremor, Slurred speech, Hypotonic reflexes, Dysdiadochokinesia. ( or Dementia ) Marcus Gunn Pupil Marcus Welby, M.D. "knows". Robert Young was also in "Father Knows Best". [b]D-R K-N-O-W-S[/b] D-Deafferentation of the pupillary light reflex
R-Retrobulbar optic neuritis K-Kan't kick inward: afferent limb defect
N-No constriction to direct light stimulation
O-Optic nerve (CN II) damaged unilaterally
W-swinging flashlight test
S-consensual reflex intact Subarachnoid hemorrhage (SAH): Rupture of an aneurysm releases blood directly into the cerebrospinal fluid (CSF) under arterial pressure. Clinical manifestations: CSF ~ FDR F-D-R's Last Words: O! CAN'T W-H-I-P 'E-M F-Focal signs: limb weakness, dysphagia, CN III palsy
D-Depression of consciousness with headache
R-Retinal (subhyaloid) hemorrhage Last-Lucidity with headache is the usual pattern of onset. Words-Warning leak sign of impending rupture (controversial sign). O-(looks like eyes) CN III palsy Can't extend knees (Kernig's sign) W-circle of Willis
H-Headache: sudden onset of severe headache ("the worst headache of my life")
I-Increased ICP
P-Papilledema E-Epileptic seizures
M-Meningismus Subarachnoid hemorrhage : Ruptured berry aneurysm A-Adult polycystic kidney disease, Anterior communicating artery
B-Berry aneurysm
C-Circle of Willis
D-Danlos-Ehlers and Marfan's syndromes [b]Causes of Syncope: F-A-D-E-O-U-T[/b] F-Faint simple vasovagal fainting
A-Arrhythmia causing cardiac syncope
D-Drugs: alcohol, illicit drugs, nitrates, antihypertensives, sympathetic blockers
E-Eyeball pressure
O-Orthostatic hypotension: dysautonomias
U-Undiagnosed seizures
T-Takayasu's arteritis: reduced cerebral blood flow due to involvement of the carotid and vertebral arteries. [b]Causes of Vertigo: revolving, P-I-V-O-T-I-N-G M-E-N [/b] P-Petrositis, benign Positional vertigo
I-Ischemic attacks: transient vertebrobasilar ischemic attacks
V-Vestibular neuronitis
O-Other Otogenic causes: Otosclerosis, herpes zoster Oticus, Obstructed external auditory canal
T-Tumors of the middle ear, labyrinth, pons, cerebellopontine angle, CN VIII
I-Internal auditory artery occlusion
N-Neuronitis: acute vestibular neuronitis
G-Giant cell arteritis - internal auditory artery occlusion M-Meniere's disease
E-Ear: otitis media, labyrinthitis, barotrauma
N-Neuromas: acoustic neuromas [b]Headache: S-T-O-I-C M-P[/b] S-Sentinel headache that precedes a major subarachnoid hemorrhage (SAH)
T-Temporomandibular joint dysfunction, Tension-type headache, Tumors
O-Other: pressure, traction, or displacement of extracerebral structures.
I-Indomethacin-responsive headache
C-Cluster headache M-Meningitis, Migraine headache
P-Posttraumatic headache, Paranasal sinuses Intracerebral hemorrhage: T-I-P Ur H-A-T to M-Ds T-Trauma
I-Idiopathic
P-Penia ? thrombocytopenia Ur-Vasculitis H-Hypertension
A-Amyloid angiopathy
T-Tumors associated with bleeding M-Malformations: AV
D-blood Dyscrasias
You can do it, we can help!
Prab, Moderator
>> MM's original name was Norma [Normochromic normocytic] Jean. Bone pain and pathologic fractures: predominantly osteolytic tumors and osteoporosis.
>> MM's name was illuminated in marquee Lights [osteoLytic], but she
>> secretly longed for
an Oscar award [Osteoporosis]. Susceptibility to bacterial infections.
>> MM was Susceptible to Toxic [infections] relationships. Acute renal failure (ARF) due to the effects of filtered light-chain proteins,
hypercalcemia, and amyloid deposits in the kidney.
>> MM's Lightly-Chained ARF dog barked when MM's death was said to be
>> related to her
JFK Army-Lord [Amyloid]. -Laboratory Hypercalcemia
>> MM fluffed White Talcum [hypercalcemia] powder on her delicate white
>> skin... Hypergammaglobulinemia
>> ...to protect it from the movie industry's Large hot Camera
>> lights[hyperGammaglob]. Serum electrolytes: Low anion gap
>> MM wore gowns with Low [Low anion gap] revealing necklines. Rouleaux on peripheral blood smear.
Occasionally Coombs(+) hemolytic anemia.
>> MM used hair Rollers [Rouleaux] and Combs [Coombs] to create her
>> famous hairdo. Leukocyte alkaline phosphatase (LAP) staining reaction: High LAP score.
>> MM used her Great LAP to her advantage because.... Normal levels of Serum Alkaline Phosphatase (SAP)
>> ...she was Not a SAP. Antineoplastic agents & Adverse effects Male testicular tumors: "S-E-C sac T-I-C-S?? S-Seminoma: most common
E-Embryonal carcinoma
C-Choriocarcinoma Sac-Yolk sac tumor (endodermal sinus tumor) T-Teratoma, Teratocarcinoma
I-C-Interstitial (Leydig) cell tumor
S-Sertoli cell tumor Paraneoplastic syndromes and their associated cancers: Your diagnosis can be "Highly S-C-R-A-M-B-L-E-D." Highly-Hypercalcemia (squamous cell carcinoma) S-SIADH, hyponatremia (SCLC)
C-Clubbing (adenocarcinomas)
R-Retinal blindness (SCLC)
A-ACTH (SCLC)
M-Myasthenia gravis (thymoma)
B-Bone - hyperosteoarthropathy (adenocarcinomas)
L-Limbic encephalitis (SCLC)
E-Eaton-Lambert myasthenic syndrome (SCLC)
D-Dermatomyositis (cancer of the lung, ovary, breast, stomach; NHL) SIADH: Syndrome of inappropriate antidiuretic hormone secretion
SCLC: Small cell lung cancer
NHL: non-Hodgkin's lymphoma [b]Microbiology [/b] The first two mnemonics are modifications of well-known mnemonics. -Gram-positive, spore-forming, rods: Bacillus and Clostridium Some love stay home forming spores:
Basically Claustrophilic (Bacilli and Clostridia) -Other gram-positive rods: Others love to belong: C-L-A-N C-Corynebacterium
L-Listeria
A-Actinomyces
N-Nocardia All species within the Enterobacteriaceae family are gram-negative enteric bacilli and are facultative anaerobes that can ferment glucose to acid. When microorganisms compete with humans for glucose, they are Nasty CURSESS." Nasty-Neisseria (N. gonorrhoeae and N. meningitides) C-Curved: Vibrio and C-Campylobacter species
UR-Urease-positive
SE-Serratia
SS-Salmonella, Shigella Urease(+): Y. enterocolitica, Y. pseudotuberculosis, P. mirabilis, P. vulgaris, M. morgani Clinically significant Anaerobes "A Closed Box For Pepsi." A-Actinomyces G+
C-Clostridia- G+
B-Bacteroides G-
For Fusobacterium G-
Pepsi Peptostreptococci G+ Bloody diarrhea Bloody diarrhea may be caused by invasive bacteria or parasites, including: Campylobacter, Shigella, Salmonella, Yersinia, and Trichuris (whipworm). The Cutting edge of the Campbell's [Campylobacter] soup can was Bloody. The Shaggy [Shigella] surface was Abrasive [Bloody]. The Salmon [Salmonella] scales were Abrasive [Bloody]. The Jersey [Yersinia] sweatshirt was rough and Abrasive [Bloody]. The Bullwhip [Whipworm] drew Blood. Bordetella pertussis: Whooping cough Bordetella pertussis is the etiologic agent of whooping cough. -Laboratory: Absolute lymphocytosis in children (a reportedly recent USMLE Step 2 question). >> Many crossed the Border [Bordetella] for their Green* cards [lymphocytosis].
*In our color-coding scheme of mnemonics, green will represent lymphocytes. B-O-R-D-E-T-E-L-L-A B-Bordet-Gengou agar culturing a nasopharyngeal swab is the standard diagnostic test ordered during the
first 2 weeks of onset.
O-whOoping cough
R-Rod: B. pertussis is a small, gram-negative pleomorphic rod D-DFA - Direct fluorescent antibody test of nasopharyngeal secretions results in frequent false-positives. E-Erythromycin for therapy and prophylaxis. T-Trimethoprim-sulfamethoxazole is an alternative antibiotic choice. E-ELISA is the diagnostic test ordered after the first 2 weeks of onset. L-Leukocytosis: 10,000 - 50,000 cells/uL with 50-75% mature lymphocytes L-Lymphocytosis in children A-Adult lymphocytosis is rare. [b]Organisms that Spread from Blood to Urine
CASH CML [/b]
C - candida
A - aureus staph
S - salmonella
H - histoplasma
C - cytomegalo virus
M - mycobacteria
L - leptospira
Submitted by Ousama Dabbagh M.D Acute Rheumatic Fever
There are several for the major criteria, I use "JONES"
J - Joints
O - Obvious (cardiac) - sorry, I know this is kinda weak
N - Nodules (subcutaneous nodules)
E - Erythema marginatum
S - Syndeham's Chorea Kawasaki's "scream fever"
S - sausage fingers
C - conjunctival redness
R - rash
E - extremity involvement
A - adenopathy
M - mucosal erythema
FEVER - fever [b]Causes of post op fever )[/b] Remember the following mnemonic when determining the possible cause(s) of fever in a patient who has recently undergone a surgical procedure: the 5 W's (or 6 W's
Wind : the pulmonary system is the primary source of fever in the first 48 hours. ( Atelectasis, pneumonia ect.)
Wound : there might be an infection at the surgical site.
Water : check intravenous access site for signs of phlebitis.
Walk : deep venous thrombosis and pulmonay embolism can develop due to pelvic pooling or restricted mobility
Whiz : a urinary tract infection is possible if urinary catheterization was required.
Also Wonder drugs - drug fevers. (added by Calvin Lee) [b]Classification of hypersensitivity reactions[/b]
"ACID"
Type I Anaphylaxis
Type II Cytotoxic - mediated
Type III Immune - complex
Type IV Delayed hypersensitivity [b]Criteria for Lupus
SOAP BRAIN MD [/b]Serositis (pleuritis, pericarditis)
Oral Ulcers
Arthritis
Photosensitivity
Blood (all are low - anemia, leukopenia, thrombocytopenia)
Renal (protein)
ANA
Immunologic (DS DNA etc.)
Neurologic (psyc, seizures)
Submitted by Mike Ritter, MD FAAEM, San Diego, CA Risk of underlying malignancy with dermatomyositis or polymyositis is 30% at age 30, 40% at age 40 etc. Blue Sclera: "MIXED"
? M = Marfans ,
? I = Imperfecta ( Osteogenesis )
? XE =(pseudo) Xanthoma elasticum
? ED = Ehlers Danlos
?
You can do it, we can help!
Prab, Moderator