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E - Electrolytes
L - LBBB
E - Early Repolarization
V - Ventricular hypertrophy
A - Aneurysm
T - Treatment - Pericardiocentesis
I - Injury (AMI, contusion)
O - Osborne waves (hypothermia)
N - Non-occlusive vasospasm
If QRS complex is wide, consider bundle branch block. LBBB causes a "W" pattern in V1-2 and a "M" pattern in V5-6. RBBB is the other way round. Remember as WiLLiaM MaRRoW.
-The mnemonic key is Arthur Shawcross (AS), a cannibalistic murderer, a key which immediately
follows the symbol.
-Clinical:
Angina pectoris despite normal coronary arteries
Arthur Shawcross represents the Angel of death [Angina].
Exertional syncope
His victims Swooned [Syncope] with fear when they saw him.
Exertional dyspnea of congestive heart failure
Arthur Shawcross claims he left the crime scenes whistling Dixie [Dyspnea].
Sudden cardiac death
Arthur Shawcross causes Sudden Death.
-Physical findings
Loud, harsh, systolic ejection murmur at the upper right sternal border, usually
associated with a palpable systolic thrill.
Arthur Shawcross is a Base [Basal] Thrill-murderer [Thrill].
He is a Harsh Hardened criminal, who attributed his grotesque actions to
incest with his Sister [Systolic].
S4 gallop is common and represents left ventricular hypertrophy and increased
left ventricular pressure.
His ghoulish tales read like the Four [S4] Horsemen of the Apocalypse.
S3 when left ventricular failure is present.
As a child, AS displayed the classic homicidal Triad [S3]: animal torture,
fire-setting, and bed-wetting.
Delayed upstroke in the carotid pulse. Parvus et tardus carotid pulse.
His last victim still had a Small but palpable pulse. However, the ambulance was
Delayed [upstroke], and, it soon became too Little, too Late [Parvus et Tardus].
Paradoxical splitting of S2
AS sent his victims to Paradise [Paradoxical].
References:
1. Harrison Principles of Internal Medicine, 14/e Edition, McGraw-Hill, New York, 1998.
2. Maximum access to diagnosis and therapy (MAXX), Lippincott Williams & Wilkins, New York, 1999
-The mnemonic key is MicroSoft (MS), a key which immediately follows the symbol.
-Physical findings:
The thrill at the apex is the diastolic murmur.
>> Hopeful applicants at the Apex of their careers are Thrilled to be hired by
MicroSoft.
The left ventricle (LV) is of normal pressure and size, so the point of maximum impulse
is not displaced to the left.
>> MS owns a Healthy Windows [Vented: Normal LV] environment, and is Not willing
to be Displaced from its location.
High-pitched opening snap [OS] following S2, heard best between the second to
fourth left intercostal space.
>> The new Windows98 Operating System [OS] sold at a High-pitched pace.
S1 is loud and snapping.
>> MicroSoft 1-sound is Bill Gates [S1], who barks out Loud Snapping orders.
-Chest x-ray:
Kerley B lines (dilated interlobular septa or septal edema) are horizontal, nonbranching
lines at the peripheral lower lung fields.
>> The Curly-haired [Kerley B lines] computer geek...
The large left atrium straightens the left heart border and is suggested by a double
density right-heart border, by the posterior displacement of the esophagus, and
by an elevated left mainstem bronchus.
>> ...stole Double Density [CXR] diskettes to be sold in Los Angeles [large LA].
-Catheterization:
The left atrial (LA) pressure pulse reveals a prominent "a wave (LA contraction
against the mitral valve).
>> Those trying to enter the ranks of MS had to show Prominent A grades ["a wave]
at the Apex [Apical diastolic murmur] of their class.
References:
1. Harrison Principles of Internal Medicine, 14/e Edition, McGraw-Hill, New York, 1998.
2. Maximum access to diagnosis and therapy (MAXX), Lippincott Williams & Wilkins, New
York, 1999.
H - hypoglycemia hypoxia
E - epilepsy
A - anxiety [the "swoon"]
D - dysfunction of brain stem [i.e. brain stem TIA]
H - heart attack
E - embolism of pulmonary artery
A - aortic obstruction [ Aortic stenosis, myxoma, IHSS ]
R - rhythm disturbance
T - tachycardia esp VT
V - vasovagal
E - ectopic i.e. hemorrhage obvious or not
S - situational [micturation, defecation...]
S - subclavial steal
L - low SVR [eg: anaphalaxis]
S - sensitive carotid sinus
95% of hypertension is primary (idiopathic). 5% is secondary and causes include CHAPS - Cushing's syndrome, Hyperaldosteronism (Conn's syndrome) , Aorta coarctation, Pheochromocytoma, Stenosis of the renal arteries.
As Easy as 'LMNOP' : Remember the mnemonic LMNOP when treating a patient with acute pulmonary edema
Lasix’η (furosemide) intravenous (IV), one to two times the patient's usual dose, or 40 mg if the patient does not usually take the drug.
Morphine sulfate. Initial dose, 4 to 8 mg IV (subcutaneous administration is effective in milder cases); may repeat in 2 to 4 hours. Avoid respiratory depression. Morphine increases venous capacity, lowering left atrial pressure, and relieves anxiety, which reduces the efficiency of ventilation.
Nitroglycerin IV, 5 to 10 ug/min. Increase by 5 ug/min q 3 to 5 minutes. Reduces left ventricular preload. Caution: may cause hypotension.
Oxygen, 100% given to obtain an arterial PO2>60 mm Hg.
Position patient sitting up with legs dangling over the side of the bed. This facilitates respiration and reduces venous return.
ACE - Angiotensin converting enzyme levels monitor disease activity and response to therapy.
Schaumann's bodies (inclusions)
B-Bell's palsy, Bilateral hilar lymphadenopathy, Black females
O-Optic nerve dysfunction is a common manifestation of neurosarcoid.
E-Eyes: uveitis
K-Kveim skin test
S-Sulfonylureas
A-Adrenal insufficiency
U-Under 0.3 (insulin/glucose ratio) to make the diagnosis
C-C-peptide measurement to rule out factitious hypoglycemia
E-Endocrine: Epinephrine, glucagon deficiencies (counterregulatory hormone deficiencies)
I-Immune disease with insulin or insulin receptor antibodies
S-Sarcomas: large retroperitoneal sarcomas
M-Maple syrup urine disease, severe Malaria
S-Salicylates in children
G-Galactosemia (with milk ingestion), disorders of Gluconeogenesis
Remember the following mnemonic when evaluating patients for hyperthyroidism:
S : Sweating
T : Tremor or Tachycardia
I : Intolerance to heat, Irregular menstruation, and Irritability
N : Nervousness
G : Goiter and Gastrointestinal (loose stools/diarrhea).
Submitted by Jed
S - Sarcoidosis
H - Hyperparathypoidism, Hyperthyroidism
A - Alkali-milk syndrome
M - Metastases, myeloma
P - Paget disease
O - Osteogenesis imperfecta
O - Osteoporosis
D - Vitamin intoxication
I - Immobility
R - RTA
T - Thiazides
MEN I is 3 P's (Pituitary, Parathyroid, Pancreas). MEN II is 2 C's (Catecholamines ie. pheochromocytome, carcinoma of medulla of thyroid) and Parathyroid (IIa) or Mucocutaneous neuromas (IIb).
The most common thyroid carcinoma is P-apillary (P-opular). It also has P-sammona bodies on histology. It causes P-alpable lymph nodes (lymphatic spread).
There are two that I know of (most people use "CRITOE"):
C - Capitellum
R - Radial head
I - Internal (medial epicondyle)
T - Trochlea
O - Olecranon
E - External (lateral epicondyle)
These appear at 2, 4, 6, 8, 10, and 12 years of age in order and go away two years later.
The other mnemonic I know for the ossification centers is "Come Rub My Tree Of Love" where the "M" is medial epicondyle and the "L" is the lateral epicondyle.
NEPHROTIC SYNDROME (NS) is characterized by the following: [By Shweta]
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.
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
AKA ?ADPKD
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].
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
References:
1. Harrison Principles of Internal Medicine, 14/e Edition, McGraw-Hill, New York, 1998.
2. Bennett WM and Rose BD. Polycystic kidney disease, UpToDate v8.2, (Rose, BD, ed), UpToDate, Inc, Wellesley, MA, 2000.
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.
-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]
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.
Characteristic features of multiple myeloma on X-ray are ABCDE - Asymmetry, Border irregular, Colour irregular, Diameter usually > 0.5cm, Elevation irregular.
--> 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.
References:
1. Harrison's Principles of Internal Medicine, 14/e Edition, McGraw-Hill, New York, 1998.
2. Maximum access to diagnosis and therapy (MAXX), Lippincott Williams & Wilkins, New York, 1999.
3. Scientific American Medicine (SAM-CD), Scientific American Inc, New York, 1997.
-The mnemonic key for multiple myeloma (MM) is Marilyn Monroe (MM), a key which immediately follows
the >> symbol.
-Clinical:
Weakness and fatigue due to normochromic normocytic anemia.
>> 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.
References:
1. Harrison's Principles of Internal Medicine, 14/e Edition, McGraw-Hill, New York, 1998.
2. Maximum access to diagnosis and therapy (MAXX), Lippincott Williams & Wilkins, New York, 1999.
3. Scientific American Medicine (SAM-CD), Scientific American Inc, New York, 1997.
SIADH: Syndrome of inappropriate antidiuretic hormone secretion
SCLC: Small cell lung cancer
NHL: non-Hodgkin's lymphoma
References:
1. UpToDate v8.2, (Rose, BD, ed), UpToDate, Inc, Wellesley, MA, 2000.
2. Scientific American Medicine (SAM-CD), Scientific American Inc, New York, 1997.
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."
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.
References:
1. Harrison Principles of Internal Medicine, 14/e Edition, McGraw-Hill, New York, 1998.
2. Scientific American Medicine (SAM-CD), Scientific American Inc, New York, 1997.
3. Maximum access to diagnosis and therapy (MAXX), Lippincott Williams & Wilkins, New York, 1999.
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)
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.
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
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
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
-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
Reference:
*From Harrison Principles of Internal Medicine, 14/e Edition, McGraw-Hill, New York, 1998.
Abetalipoproteinemia is a rare autosomal recessive disorder that occurs primarily in Ashkenazi
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.
References:
1. Principles of Neurology, 6th Edition, McGraw-Hill, New York: 965, 1347; 1997.
C - Cocaine condoms/ chloral hydrate/ calcium
H - Heavy metals
I - Iron/ iodides
P - Psychotropics (TCA, phenothiazines)
E - Enteric coated/BA
S - Solvents (CCl4)
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)
Tuesday 23rd of May 2006 10:12:17 PM (4 years ago)
#8
That's brilliant, cheers...is there a GET SMASHED for acute pancreatitis? There's ODEVICES and PCBRASS for drugs that alter hepatic metabolism of other drugs.
Tuesday 27th of March 2007 03:57:19 AM (3 years ago)
#15
FEAR OF HEART DISEASE
Diseases of the heart and circulation are so common and the laity is
so well acquainted with the major symptoms resulting from these disorders
that patients, and occasionally physicians, erroneously attribute
many noncardiac complaints to cardiovascular disease. The combination
of the widespread fear of heart disease with the deep-seated
emotional connotations concerning this organs function results in the
frequent development of symptoms that mimic those of organic disease
in persons with normal cardiovascular systems. The unraveling
of symptoms and signs due to organic heart disease from those not
directly related is an important and challenging task in such patients.
Patients in whom heart disease has been confirmed, especially those
who have experienced a major cardiovascular event such as a myocardial
infarction or a serious arrhythmia, are often frightened and
anxious about hospital discharge and resuming normal activity, including
sexual relations. Attention to these matters is vital in the care
of cardiac patients.
Dyspnea, one of the cardinal manifestations of heart failure, is not
limited to patients with heart disease but is also observed in conditions
as diverse as pulmonary disease, marked obesity, and anxiety (Chap.
29). Similarly, chest discomfort may result from a variety of causes
other than myocardial ischemia (Chap. 12). Whether heart disease is
responsible for these symptoms can frequently be determined by carrying
out a careful clinical examination. Noninvasive testing using
electrocardiography at rest and during exercise (Chap. 210), echocardiography
(Chap. 211), roentgenography, and myocardial imaging
usually provides important additional information to permit the correct
interpretation of symptoms; more specialized invasive examinations
(catheterization and angiography; Chap. 212)are occasionally necessary.
Tuesday 27th of March 2007 04:00:02 AM (3 years ago)
#16
This is not supposed to be an alternative sheet to the clinical test, on the contrary it is no more than a clinical aid in history taking in conjunction with the clinical text.
Personal History:
Patient name, age, sex, profession, place of origin, current residence, marital status, parity (state the number of sons and daughters only)
Special habits of medical importance: (specify duration of each habit & clinical complications if any).
N.B. Do not start your personal history with the following: Name age etc .. (do not use titles) e.g. Hany, 45 yrs old male, engineer born in . & lives in ., married & has 2 sons.
Complaint:
Should always be:
- The single most important driving symptom that brought patient to medical advice (do not multiply symptoms in the complaint).
- Should be in English, never in Latin.
- Should include the onset, course & duration.
e.g. insidious, progressive right upper abdominal pain of 3wks duration (do not analyze the symptoms in this section).
Present history:
Should start with the following question:
When did the problem start? Or tell me when was the last time you have been feeling well?
The student should use one of these forms to start and date the present history.
The symptoms should be arranged chronologically with consideration to the symptom relevance.
For example, the patient may say "my legs were swollen and I notice that I became jaundiced" here the student should analyse lower limb edema first by asking direct questions like did you notice puffins in the eye lids? Did your abdomen got swollen as well? Before the patient takes him to jaundice and sequential arrays of symptoms.
The student should not move from one symptom to another unless each is fully analyzed.
GIT questionnaire must include: sore mouth, anorexia, pyrosis, heartburn, dysphagia, abdominal pain, distension, changing bowel habits "especially recent change in the bowel habit", hematemsis, melina, hematochezia.
Cardiopulmonary questionnaire: chest pain (this is a serious symptom and should be perfectly analyzed especially in middle age man), dyspnea (grading and different forms as PND, orthopnea, platypnea should be enquired), cough (dry or wet, diurnal or nocturnal, relation to posture), palpitations, wheezing, cyanosis.
Hematological symptoms: bleeding tendency, easy bruisability, hemolytic attacks, family members involved.
Nephrology questionnaire: flank pains, hematuria, stone passage, untreated hypertension, neglected diabetes, nephrotoxic drug history, renal failure subjects on dialysis.
Neurological questionnaire: headache of recent onset, dizziness and fainting, abnormal sensations (parasthesia), visual disturbances, sphincteric problems and seizures.
Muscukoskeletal questionnaire: joint pains (specify the joint involved and when do they get worse), muscle pains and weakness, nuchal and back pains.
The student should never forget to enquire about and probe other systems beyond the system of concern in the case. For example, if the patient is presenting with jaundice, ascites, and lower limb edema, here the student will be impressed by a chronic liver disease presentation and may forget completely to ask about cardiac symptoms which may be the reason behind the liver failure (e.g., cardiac cirrhosis).
Past history: Should include similar attacks, surgeries, blood transfusion, hospital admission, detailed drug history, diabetes and hypertension, fits and faints, traveling to endemic regions, contact with infectious cases, sexual history in relevant cases.
Family history:
Malignancy, diabetes, hypertension, similar condition in the family must all be elicited.
The student should learn in the last two minutes in the history taking process how to rearrange the key presenting symptoms in short and chronologically to make up a reasonable deductive summary of a history. He may ask the patient in the end if he would like to add any more information. The student should learn to take notes in his sheet concerning how the patient describe his symptoms, his facial expression during history taking, how he uses his hands to demonstrate his pains, etc..
Sunday 28th of October 2007 08:50:25 PM (2 years ago)
#20
excellent mirza!!!!!!!!!!!! thanq very much i have one Glassgow criteria-simplified Ransons criteria PANCREAS P-PaO2 A-albumin N- nitrogen C-calcium R-raisedTc E-enzymeLDH A-age S-sugar severe disease>3factors
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