Causes of acute Pancreatitis
BAD SHIT
Black scorpion bite
Alcohol ( or autoimmune : PAN )
Drugs ( tetracycline, azothioprin, sulfa, diuretics )
Stones ( gallstones or steroid )
Hyperlipidemia
Infection ( mumps )
Trauma
Small Bowel Obstruction
“SHAVIT”
S – Stone (gallstone ileus)
H – Hernia
A – Adhesions
V – Volvulus
I – Intussusception
T – Tumor
Non-GI Causes of Vomiting
ABC’s of Non- GI causes of vomiting
Acute renal failure
Brain (Increased ICP)
Cardiac (Inferior MI)
DKA
Ears (labyrinthitis)
Foreign substances (Tylenol, theo, etc)
Glaucoma
Hyperemesis Gravidarum
Infections (pyelonephritis, meningitis)
Extraintestinal manifestations of I. B. D. are A PIE SAC -
Aphthous ulcers, Pyoderma gangrenosum, Iritis, Erythema nodosum, Sclerosing cholangitis, Arthritis, clubbing.
Which I. B. D. has C-obblestones on endoscopy – C-rohn’s.
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.
Basal Systolic Murmur: Aortic Stenosis (AS)
-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].
Apical Diastolic Murmur: Mitral Stenosis (MS)
-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.
Symptoms of aortic stenosis are SAD or ASD – Syncope, Angina, Dyspnea.
For Causes of A-Fib/Flutter
H = cHf, other cardiomyopathies
E = Enlargement of the atria
A = Alcohol binge drinking
R = Rheumatic heart disease
T = hyperThyroid
Asystole
“3 Hypo’s & 3 Hyper’s”
Hypoxia
Hypothermia
Hypokalemia
Hyperkalemia
Hyper H (Acidosis)
Hyper Rx (Drugs/OD)
Submitted by Tag Filley, M.D.
Syncope
“HEAD, HEART and VESS’LS”
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
of M.I. is BOOMAR – Bed rest, Oxygen, Opiate, Monitor, Anticoagulate, Reduce clot size Proven MI.. should be met by M.O.N.A.
M = morphine
O = oxygen
N = nitrates
A = aspirin
suspected right ventricular MI suspected .. hold the Nitrates. submitted by Chris
Mnemonic for remembering antiarrhythmics
Class Drug Mnemonic Read as: Professor Quackers “dissed” – Lydia’s penny Mexican tacos. – Feeling profaned, – proper Bertha Butt – (amiable British socialite) – virtually dismembered ‘im. or Professor Quackers dissed Lydia’s Penny Mexican Tacos. Feeling profaned, proper Bertha Butt, (amiable British socialite), virtually dismembered ‘im.*Note: “Dissed” is used here as the slang term “dis” – from dismiss. I.e., “Don’t ‘dis’ me, man!”
Class IA Procainamide Professor
Quinidine Quackers
Disopyramide “dissed” *
Class IB Lidocaine Lydia’s
Phenytoin penny
Mexiletine Mexican
Tocainide Tacos
Class IC Flecainide feeling
Propafenone profaned
Class II Propranolol proper
Beta Blockers Bertha Butt
Class III Amiodarone amiable
Bretylium British
Solatol socialite
Class IV Verapamil virtually
Diltiazem dismembered ‘im
Atropine
Adenosine
Endocarditis
“FAME”
F – FEVER
A – ANEMIA
M – MURMUR
E – ENDOCARDITIS
Causes of pericarditis are CARDIAC RIND – Collagen vascular disease, Aortic aneurysm, Radiation, Drugs eg. hydralazine, Infections, Acute renal failure, Cardiac infarction, Rheumatic fever, Injury, Neoplasms, Dressler’s syndrome.
5 T’s of early cyanosis in congenital heart disease
• Tetralogy, Transposition, Truncus, Total anomalous, Tricuspid atresia
Sumbitted by Ben Humphreys
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.
Takayasu’s disease is also called pulseless disease, therefore I can’t Tak’a ya’s pulse.
Henoch-Schonlein Purpura
“JARS”
J – Joints
A – Abdominal pain
R – Renal
S – Skin
Compartment Syndrome
“6 p’s”
pulselessness
pain
pallor
parasthesia
poikiolothermia
paralysis
Predisposing Conditions for Pulmonary Embolism TOM SCHREPFER
• T–trauma
• O–obesity
• M–malignancy
• S–surgery
• C–cardiac disease
• H–hospitalization
• R–rest (bed-bound)
• E–estrogen, pregnancy, post-partum
• P–past hx
• F–fracture
• E–elderly
• R–road trip
(Cot)Caught by Sin : Cottonà BySSinosis
Shortness of Breath
HAPISOCS
H: History of any pulmonary disease
A: Activity at onset
P: Pain upon inspiration
I: Infections fever/chills
S: Smoker years/packs
O: Orthopnea
C: Cough (Persistent)
S: Sputum Productive/color
Non-Cardiogenic Pulmonary Edema
“PONS”
P – Phosgene, paraquat, phenothiazines
O – Opioids/organophosphates
N – Nitrous dioxide
S – Salicylates
Treatment of acute pulmonary edema
As Easy as ‘LMNOP’ : Remember the mnemonic LMNOP when treating a patient with acute pulmonary edema
• Lasix¢ç (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.
Beta-1 receptors are in the heart (you have 1 heart) and beta-2 receptors are in the lungs (you have 2 lungs).
Decreased Pleural fluid Glucose : “IRAN”
• I=Infections
• RA=Rheumatoid arthritis
• N=Neoplasia
Anterior Mediastinal Mass
“4 T’s”
T – Thymoma
T – Teratoma
T – Thyroid tumor/goiter
T – Terrible lymphoma
Middle Mediastinal Mass
“Habit5″
H – Hhernia, hematoma
A – Aneurysm
B – Bronchogenic cyst/duplication cyst
I – Inflammation (sarcoid, histo, coccidio, TB)
T5 – Tumors (lung, lymphoma, leukemia, leiomyoma, lymph node hyperplasia)
Bilateral Hilar Adenopathy
“Please Helen Lick My Popsicle Stick”
P – Primary TB
H – Histoplasmosis
L – Lymphoma
M – Metastases
P – Pneumoconiosis
S – Sarcoidosis
Sarcoidosis:
SARCOIDOSIS: G-E-R-M-A-N ACE “SCHAUMANN” B-O-E-K
G-Granulomas
E-Erythema nodosum
R-Restrictive lung defect (PFTs)
M-Multiple systemic manifestations
A-Asteroid bodies (inclusions)
N-Noncaseating granuloma, Negative TB test
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
Rat Poisons
“RATS PANIC” I’m sure that you’ll easily remember this one!
R – Red squill
A – Arsenicals
T – Thallium
S – Strychnine
P – PNU/Phosphorus/zn Phosphide
A – Alpha naphtha thiurea (ANTU)
N – Norbormide
I – Indanediones
C – Coumadin/cholcalciferol
Anion Gap Acidosis:
“Mudpiles”
M – Methanol
U – Uremia
D – DKA/AKA
P – Paraldehyde/phenformin
I – Iron/INH
L – Lactic acidosis
E – Ethylene glycol
S – Salicylates
Normal Gap Acidosis
“HARDUP”
H – Hyperalimentation/hyperventilation
A – Acetazolamide
R – RTA
D – Diarrhea
U – Ureteral diversion
P – Pancreatic fistula/parenteral saline
Osmolar Gaps
“ME DIE”
M – Methanol
E – Ethanol
D – Diuretics (mannitol, sorbitol, glycerol)
I – Isopropanol
E – Ethylene glycol
Respiratory Alkalosis: Asthmatic Sally poisoned POPE’s HEN
• Asthma
• Salicylate poisoning
• PO= Pulmonary Oedema
• PE= Pulmonary Embolism
• HEN= Hepatic Encephalopathy
Hypoglycemia
“Reexplain”
R – renal failure
EX – exogenous
P – pituitary
L – liver failure
A – alcohol
I – insulinoma/infection
N – neoplasm
Hypoglycemia [By Sung Kim]
Hypoglycemia – H-U-N-G-E-R: B-E-S-T S-A-U-C-E I-S M-S-G
H-Hepatic failure (advanced), Hypothermia
U-Uremia/renal failure
N-Nausea, vomiting
G-Growth hormone deficiency
E-Ethanol metabolism blunts gluconeogenesis
R-Reye’s syndrome
B-Beta blockers
E-Enzyme defects (glycogen storage diseases)
S-Sepsis
T-Tumors: Islet beta cell tumors (pancreatic): Insulinomas
Non-islet cell tumors: Large mesenchymal tumors
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
Symptoms of hyperthyroidism
• 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).
CUSHING’S
• DISEASE is
• Dependent on (Pituitary) and
• Depresses ( Cortisol) on
• Daddy Doses of Dexa(High doses of Dexamethasone).
Hypercalcemia
“SHAMPOO DIRT”
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
Hypercalcemia symptoms are Bones (pain), Stones (renal), abdominal Groans (pain) and psychic moans (confusion).
Multiple endocrine neoplasia
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).
The most common symptoms of PHEochromocytoma begin with the first 3 letters – Palpitations, Headache, Episodic diaphoresis (sweating).
Tumors that go to bone
“Kinds Of Tumors Leaping Primarily To Bone”
K – Kidney
O – Ovarian
T – Testicular
L – Lung
P – Prostate
T – Thyroid
B – Breast
Causes of joint pain are SOFTER TISSUE – Sepsis, Osteoarthritis, Fractures, Tendon/muscle, Epiphyseal, Referred, Tumour, Ischaemia, Seropositive arthritides, Seronegative arthritides, Urate, Extra-articular rheumatism (eg. polymyalgia).
Ossification centers of the elbow
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.
Wrist Bones
“Never Loosen Tillies Pants, Mother Might Come Home”
Proximal row:
N – Navicular
L – Lunate
T – Triquetrium
P – Pisiform
Distal row:
M – greater Multiangular (trapezium)
M – lesser Multiangular (trapezoid)
C – Capitate
H – Hamate
Also: “Some Lovers Try Positions That They Can’t Handle”
Rotator Cuff Muscles
“SITS”
S – Supraspinatus
I – Infraspinatus
T – Teres minor
S – Subscapularis
The Salter Classification:
“SALTR”
S – Slip of physis
A – Above physis
L – Lower than physis
T – Through physis
R – Rammed physis
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.
C = hyperCoagulable state
Henoch-Schonlein Purpura
“JARS”
J – Joints
A – Abdominal pain
R – Renal
S – Skin
Causes of hematuria
• 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
Hereditary cystic disorders: Polycystic kidney disease
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].
-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
Renal Pathology Buzz words
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
Eosinophilia
“NAACP”
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.
Disseminated intravascular coagulation (DIC)
D-I-S-S-E-M-I-N-A-T-E-D
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.
Á¦ 9 Àå Á¾¾ç Áúȯ
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/¥ìL] 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.
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.
Hodgkin’s lyphoma classification – A = Asymptomatic, B = Bad.
Risk of underlying malignancy with dermatomyositis or polymyositis is 30% at age 30, 40% at age 40 etc.
Malignant Monoclonal Gammopathies: Multiple myeloma
-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.
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
Microbiology
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.
Organisms that Spread from Blood to Urine
CASH CML
C – candida
A – aureus staph
S – salmonella
H – histoplasma
C – cytomegalo virus
M – mycobacteria
L – leptospira
Submitted by Ousama Dabbagh M.D
Kawasaki’s
“scream fever”
S – sausage fingers
C – conjunctival redness
R – rash
E – extremity involvement
A – adenopathy
M – mucosal erythema
FEVER – fever
Causes of post op fever
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)
Classification of hypersensitivity reactions
“ACID”
Type I Anaphylaxis
Type II Cytotoxic – mediated
Type III Immune – complex
Type IV Delayed hypersensitivity
Criteria for Lupus
SOAP BRAIN MD
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
¯
Altered Mental Status
“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.
Level of consciousness
“AVPU”
A – alert
V – resonds to verbal stimuli
P – responds to painful stimuli
U – unconscious
Vertebral/Basilar Ischemia
4Ds
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”.
D-R K-N-O-W-S
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
Causes of Syncope: F-A-D-E-O-U-T
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.
Causes of Vertigo: revolving, P-I-V-O-T-I-N-G M-E-N
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
Headache: S-T-O-I-C M-P
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
Subdural hemorrhage: subconsciously dying¡±
-Elderly
-Slowly dying
-Alcohol
-Brain injury
____________________________________________________________________________________________
Cerebrovascular I-N-F-A-R-C-T-S
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.
Argyle Robertson Pupil
• Accomodation Reflex Present – Pupillary Reflex Absent.
Neurosyphilis [By jsara]
-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.
Pattern of Weakness in UMN lesions
• FLUE weakness FUELs Contractures
• F=Flexion,L=Lower Limb,U=Upper Limb E= Extensors
Normal Pressure Hydrocephalus
• Demented (Memory Loss)
• Dribbles (Urinary Incontinence)
• Disbalanced (Gait disorder)
TRAP to identify parkinson’s disease
• Tremor at rest (pill-rolling tremor)
• Rigidity
• Akinesia
• Posture typical of a Parkinson’s patient
Progressive Cerebellar Ataxias: Bassen-Kornzweig Acanthocytosis (Abetalipoproteinemia)
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.
Radiopaque Ingestants
“Chipes”
C – Cocaine condoms/ chloral hydrate/ calcium
H – Heavy metals
I – Iron/ iodides
P – Psychotropics (TCA, phenothiazines)
E – Enteric coated/BA
S – Solvents (CCl4)
Drugs that can go into an ET tube
“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.
History taking in EMS
“sample”
S – signs/symptoms
A – allergies
M – medications
P – past medical history
L – last oral intake
E – events leading to injury or illness
Pain scale:
“OPQRST”
O – onset
P – provocation
Q – quality
R – radiation
S – severity
T – time
Pain Scale (Revisited)
PQRSTAPPP
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
More on Pain Evaluation
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
One More Pain Mnemonic
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:
“Big Mess”
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
