Clinical Mnemonics

Transcript

CLINICAL MNEMONICS · CAUSES OF ACUTE PANCREATITIS: “GET SMASH’D” Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune(PAN), Scorpion bites, Hyperlipidemia, Drugs(azathioprine, diuretics) · A-P-G-A-R: A - appearance (color) P - pulse (heart rate) G - grimmace (reflex, irritability) A - activity (muscle tone) R - respiratory effort · Multiple Endocrine Neoplasia: Each of the MENs is a disease of three or two letters plus a feature. MEN I is a disease of 3 P’s (pituitary, parathyroid, and pancreas) plus adrenal cortex MEN II is a disease of 2 C’s(carcinoma of thyroid and catacholamines [pheochromocytoma]) plus parathyroid for MEN IIa or mucocutaneous neuromas for MEN IIB(aka MEN III) · Acute pneumonia caused by Pyogenic bacteria—PMN infiltrate · Acute pneumonia caused by Miscellaneous microbes— Mononuclear infiltrate · Takayasu’s diz = pulseless diz, therefore when you have Takayasu’s, I can’t Tak’a yu pulse. · CAGE—alcohol use screening Have you ever felt it necessary to CUT DOWN on your drinking? Has anyone ever told you they were ANNOYED by your drinking? Have you ever felt GUILTY about your drinking? Have you ever felt the need to have a drink in the morning for an EYE OPENER? · P-Q-R-S-T—eliciting and HPI and exploring symptoms P—palliative or provocative factors for the pain Q—quality of pain(burning, stabbing, aching, etc.) R—region of body affected S—severity of pain(usually 1-10 scale) T—timing of pain(eg.-after meals, in the morning, etc.) · A-S-C-L-A-S-T—eliciting and HPI and exploring symptoms A—aggravatiing and alleviating factors S—severity C—character, quality L—location A—associated sx S—setting T—timing note: ASCLAST means let the patient talk first, then ask him/her specific questions · Argyll-Robertson Pupil—syphilitic pupil: Accommodation reflex present, Pupillary reflex absent due to damage at pretectal area. Also called the “prostitute’s pupil” (accommodates but does not react). · The five W’s—post-operative fever Wind—pneumonia, atelectasis Wound—wound infections Water—urinary tract infection Walking—walking can help reduce deep vein thromboses and pulmonary embolus Wonderdrugs—especially anesthesia · 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 · ARTERIAL OCCLUSION: pain pallor pulselessness paresthesias · HYPERSENSITIVITY REACTIONS: “Anna Cycled Immediately Downhill—Gell & Goombs” or “ACID.” Type I Anaphylaxis Type II Cytotoxic-mediated Type III Immune-complex Type IV Delayed hypersensitivity · WBC Count: “Never Let Mom Eat Beans” and “60, 30, 6, 3, 1” Neutrophils 60% Lymphocytes 30% Monocytes 6% Eosinophils 3% Basophils 1: Clinical - Free Association Proud Dead Guys and Other Diseases Addison’s Disease • primary adrenocortical deficiency Addisonian Anemia • pernicious anemia (antibodies to intrinsic factor or parietal cells → ↓IF → ↓ B12 → megaloblastic anemia) Albright’s Syndrome • Vit polyostotic fibrous dysplasia, precocious puberty, café au lait spots, short stature, young girls Alport’s Syndrome • hereditary nephritis with nerve deafness, Type 4 collagen defect (basement membranes) Alzheimer’s • progressive dementia; tau proteins, neurofibrillary tangles, apolipoprotein E4 allele, narrow gyri and wide sulci (atrophy), occipital sparing, hydrocephalus ex vacuo, plaques in hippocampus and cortex, ↓ Acetylcholine, Hiramo bodies (inrtacellular inclusion bodies in hippocampal cells) Argyll-Robertson Pupil • loss of light reflex constriction (contralateral or bilateral) • “Prostitute’s Eye” - accommodates but does not react • Pathognomonic for 3°Syphilis Arnold-Chiari Malformation • cerebellar tonsil herniation Barrett’s • columnar metaplasia of lower esophagus (* risk of adenocarcinoma) Bartter’s Syndrome • hyperreninemia Becker’s Muscular Dystrophy • similar to Duchenne, but less severe (deficiency in dystrophin protein) Bell’s Palsy • CNVII palsy (entire face; recall that UMN lesion only affects lower face) Berger’s Disease • IgA nephropathy BernardSoulier Disease • defect in platelet adhesion (abnormally large platelets & lack of platelet-surface glycoprotein) Berry Aneurysm • circle of Willis (subarachnoid bleed) • often associated with ADPKD Bowen’s Disease • carcinoma in situ on shaft of penis (* risk of visceral ca) Briquet’s Syndrome • somatization disorder • psychological: multiple physical complaints without physical pathology Broca’s Aphasia • Motor Aphasia intact comprehension Bronchiolitis RSV BrownSequard • hemisection of cord (contralateral loss of pain & temp / ipsilateral loss of fine touch, UMN) Bruton’s Disease • X-linked agammaglobinemia Budd-Chiari • post-hepatic venous thrombosis Buerger’s Disease • acute inflammation of small, medium arteries * painful ischemia * gangrene Burkitt’s Lymphoma • small noncleaved cell lymphoma EBV • 8:14 translocation Caisson Disease • gas emboli Carpal Tunnel Syndrome Median nerve entrapment Chagas’ Disease • Trypansoma infection sleeping disease, cardiomegaly with apical atrophy, achlasia Chediak-Higashi Disease • Phagocyte Deficiency: neutropenia, albinism, cranial & peripheral neuropathy • repeated infections Congenital adrenal hyperplasia 21-hydroxylase deficiency: virilism, no cortisol, salt loss, hypotension 11-hydroxylase deficiency: virilism, no cortisol, salt retention, hypertension Conn’s Syndrome • primary aldosteronism Cori’s Disease • glycogen storage disease (debranching enzyme deficiency) Creutzfeldt-Jakob • prion infection * cerebellar & cerebral degeneration Crigler-Najjar Syndrome • congenital hyperbilirubinemia (unconjugated) • glucuronyl transferase deficiency Crohn’s • IBD; ileocecum, transmural, skip lesions, lymphocytic infiltrate, granulomas (contrast to UC: limited to colon, mucosa & submucosa, crypt abscesses, pseudopolyps, * colon cancer risk) Croup Parainfluenza Curling’s Ulcer • acute gastric ulcer associated with severe burns Cushing’s • Disease: hypercorticism 2* to * ACTH from pituitary (basophilic adenoma) • Syndrome: hypercorticism of all other causes (1* adrenal or ectopic) Cushing’s Ulcer • acute gastric ulcer associated with CNS trauma de Quervain’s Thyroiditis • self-limiting focal destruction (subacute thyroiditis) DiGeorge’s Syndrome • thymic hypoplasia * T-cell deficiency • hypoparathyroidism Down’s Syndrome • trisomy 21 or translocation Dressler’s Syndrome • Post-MI Fibrinous Pericarditis autoimmune Dubin-Johnson Syndrome • congenital hyperbilirubinemia (conjugated) • striking brown-to-black discoloration of the liver Duchenne Muscular Dystrophy • deficiency of dystrophin protein * MD X-linked recessive Edwards’ Syndrome • trisomy 18 • rocker-bottom feet, low ears, heart disease Ehler’s-Danlos • defective collagen Eisenmenger’s Complex • late cyanotic shunt (R→L) pulmonary HTN & RVH 2° to long-standing VSD, ASD, or PDA Erb-Duchenne Palsy • trauma to superior trunk of brachial plexus Waiter’s Tip Ewing Sarcoma • undifferentiated round cell tumor of bone Eyrthroplasia of Queyrat • carcinoma in situ on glans penis Fanconi’s Syndrome • impaired proximal tubular reabsorption 2* to lead poisoning or Tetracycline (glycosuria, hyperphosphaturia, aminoaciduria, systemic acidosis) Felty’s Syndrome • rheumatoid arthritis, neutropenia, splenomegaly Gardner’s Syndrome • adenomatous polyps of colon plus osteomas & soft tissue tumors Gaucher’s Disease • Lysosomal Storage Disease glucocerebrosidase deficiency • hepatosplenomegaly, femoral head & long bone erosion, anemia Crinkled tissue paper cells in marrow Gilbert’s Syndrome • benign congenital hyperbilirubinemia (unconjugated) GIST Tumor arising in cells of Cajal (pacemakers of gut) Glanzmann’s Thrombasthenia • defective glycoproteins on platelets Goodpasture’s • autoimmune: ab’s to glomerular & alveolar basement membranes; linear immunofluorescence Grave’s Disease • autoimmune hyperthyroidism (TSI) Guillain-Barre • idiopathic polyneuritis (ascending muscle weakness & paralysis; usually selflimiting) Hamman-Rich Syndrome • idiopathic pulmonary fibrosis Hand-Schuller-Christian • chronic progressive histiocytosis Hashimoto’s Thyroiditis • autoimmune hypothyroidism (antimicrosomal or antithyroglobulin); Hurthle cells, thyroid germinal centers, Hapooh poohoxicosis • initial hyperthyroidism in Hashimoto’s Thyroiditis that precedes hypothyroidism HenochSchonlein purpura • hypersensivity vasculitis • hemmorhagic urticaria (with fever, arthralgias, GI & renal involvement) • associated with upper respiratory infections Hereditary Spherocytosis RBC cytoskeletin defect, most commonly spectrin Hirschprung’s Disease • aganglionic megacolon Horner’s Syndrome • ptosis, miosis, anhidrosis (lesion of cervical sympathetic nerves often 2* to a Pancoast tumor) Huntington’s • progressive degeneration of caudate nucleus, putamen & frontal cortex; AD Hunter’s Decreased iduronosulfate sulfatase Hurler’s Decreased alpha-L-iduronidase Jacksonian Seizures • epileptic events originating in the primary motor cortex (area 4) Job’s Syndrome • immune deficiency: neutrophils fail to respond to chemotactic stimuli Kaposi Sarcoma • malignant vascular tumor (HHV8 in homosexual men) Kartagener’s Syndrome • immotile cilia 2° to defective dynein arms infection, situs inversus, sterility Kawasaki Disease • mucocutaneous lymph node syndrome (lips, oral mucosa) Keratoconjunctivitis adenovirus Klinefelter’s Syndrome • 47, XXY Kluver-Bucy • bilateral lesions of amygdala (hypersexuality; oral behavior) Krabbe Disease Beta-galactosidase deficiency Krukenberg Tumor • adenocarcinoma with signet-ring cells (typically originating from the stomach) metastases to the ovaries Laennec’s Cirrhosis • alcoholic cirrhosis Lesch-Nyhan • HGPRT deficiency • gout, retardation, self-mutilation Letterer-Siwe • acute disseminated Langerhans’ cell histiocytosis Libman-Sacks • endocarditis with small vegetations on valve leaflets • associated with SLE Lou Gehrig’s • Amyotrophic Lateral Sclerosis degeneration of upper & lower motor neurons Mallory-Weis Syndrome • bleeding from esophagogastric lacerations 2* to wretching (alcoholics) Marfan’s • elastin defect, floppy mitral valve, arachnodactyly, cystic medial necrosis, subluxed lens McArdle’s Disease • glycogen storage disease (muscle phosphorylase deficiency) Meckel’s Diverticulum • rule of 2’s: 2 inches long, 2 feet from the ileocecum, in 2% of the population • embryonic duct origin; may contain ectopic tissue (gastric, pancreatic, etc.) Meig’s Syndrome • Triad: ovarian fibroma, ascites, hydrothorax Menetrier’s Disease • giant hypertrophic gastritis (enlarged rugae; plasma protein loss) Monckeberg’s Arteriosclerosis • calcification of the media (usually radial & ulnar aa.), pipestem arteries Munchausen Syndrome • factitious disorder (consciously creates symptoms, but doesn’t know why) Meningioma Arachnoid cap cells, whorls of cells Mesothelioma Asbestos exposure Nelson’s Syndrome • 1* Adrenal Cushings * surgical removal of adrenals * loss of negative feedback to pituitary * Pituitary Adenoma Niemann-Pick • Lysosomal Storage Disease sphingomyelinase deficiency • “foamy histiocytes” Osler-Weber-Rendu Syndrome • Hereditary Hemorrhagic Telangiectasia Osteogenesis imperfecta Type I collagen defect Paget’s Disease • abnormal bone architecture (thickened, numerous fractures * pain) , woven and lamellar bone mosaic Pancoast Tumor • bronchogenic tumor with superior sulcus involvement * Horner’s Syndrome Parkinson’s • dopamine depletion in nigrostriatal tracts; Cogwheel rigidity Peutz-Jegher’s Syndrome • melanin pigmentation of lips, mouth, hand, genitalia plus hamartomatous polyps of small intestine Peyronie’s Disease • subcutaneous fibrosis of dorsum of penis Pick’s Disease • progressive dementia similar to Alzheimer’s, knife-edged gyri Plummer’s Syndrome • hyperthyroidism, nodular goiter, absence of eye signs (Plummer’s = Grave’s - eye signs) PlummerVinson • esophageal webs & iron-deficiency anemia, ↑ SCCA of esophagus Pompe’s Disease • glycogen storage disease (acid maltase deficiency) * cardiomegaly Pott’s Disease • tuberculous osteomyelitis of the vertebrae Potter’s Complex • renal agenesis * oligohydramnios * hypoplastic lungs, defects in extremities Raynaud’s • Disease: recurrent vasospasm in extremities • Phenomenon: 2* to underlying disease (SLE or scleroderma) Reiter’s Syndrome • “Can’t see, can’t pee, can’t climb a tree” • urethritis, conjunctivitis, arthritis non-infectious (but often follows infections), HLA-B27, polyarticular Reye’s Syndrome • microvesicular fatty liver change & encephalopathy • 2* to aspirin ingestion in children following viral illness Riedel’s Thyroiditis • idiopathic fibrous replacement of thyroid Rotor Syndrome • congenital hyperbilirubinemia (conjugated) • similar to Dubin-Johnson, but no discoloration of the liver Sezary Syndrome • leukemic form of cutaneous T-cell lymphoma (mycosis fungoides) Shaver’s Disease • aluminum inhalation → lung fibrosis Sheehan’s Syndrome • postpartum pituitary necrosis Shy-Drager • parkinsonism with autonomic dysfunction & orthostatic hypotension Simmond’s Disease • pituitary cachexia Sipple’s Syndrome • MEN type IIa (pheochromocytoma, thyroid medulla, parathyroid) Sjogren’s Syndrome • triad: dry eyes, dry mouth, arthritis ↑ risk of B-cell lymphoma Spitz Nevus • juvenile melanoma (always benign) SteinLeventhal • polycystic ovary Stevens-Johnson Syndrome • erythema multiforme, fever, malaise, mucosal ulceration (often 2° to infection or sulfa drugs) Struma Ovarii Thyroid teratoma of ovary Still’s Disease • juvenile rheumatoid arthritis (absence of rheumatoid factor) Takayasu’s arteritis • aortic arch syndrome • loss of carotid, radial or ulnar pulses Tay-Sachs • gangliosidosis (hexosaminidase A deficiency * GM2 ganglioside) Tetralogy of Fallot • ÊVSD, Ëoverriding aorta, Ìpulmonary artery stenosis, Íright ventricular hypertrophy Tourette’s Syndrome • involuntary actions, both motor and vocal Turcot’s Syndrome • adenomatous polyps of colon plus CNS tumors Turner’s Syndrome • 45, XO Typhoid Fever Bradycardia and in white people rose spots on abdomen Vincent’s Infection • “trench mouth” acute necrotizing ulcerative gingivitis von Gierke’s Disease • glycogen storage disease (G6Pase deficiency) von Hippel-Lindau • hemangioma (or hemangioblastoma) • adenomas of the viscera, especially renal cell carcinoma defect in VHL tumor suppressor von Recklinghausen’s • neurofibromatosis & café au lait spots & Lisch nodule (iris hamartomas) von Recklinghausen’s Disease of Bone • osteitis fibrosa cystica (“brown tumor”) 2* to hyperparathyroidism von Willebrand’s Disease • defect in platelet adhesion 2* to deficiency in vWF; increased bleeding time and PTT Waldenstrom’s macroglobinemia • proliferation of IgM-producing lymphoid cells Wallenberg’s Syndrome • Posterior Inferior Cerebellar Artery (PICA) thrombosis “Medullary Syndrome” • Ipsilateral: ataxia, facial pain & temp; Contralateral: body pain & temp WaterhouseFriderichsen • catastrophic adrenal insufficiency 2* to hemorrhagic necrosis (eg, DIC) • often 2* to meningiococcemia Weber’s Syndrome • Paramedian Infarct of Midbrain • Ipsilateral: mydriasis; Contralateral: UMN paralysis (lower face & body) Wegener’s Granulomatosis • necrotizing granulomatous vasculitis of paranasal sinuses, lungs, kidneys, etc. Weil’s Disease • leptospirosis Wermer’s Syndrome • MEN type I (thyroid, parathyroid, adrenal cortex, pancreatic islets, pituitary) Wernicke’s Aphasia • Sensory Aphasia impaired comprehension Wernicke-Korsakoff Syndrome • thiamine deficiency in alcoholics; bilateral mamillary bodies (confusion, ataxia, ophthalmoplegia) Whipple’s Disease • malabsorption syndrome (with bacteria-laden macrophages) & polyarthritis Wilson’s Disease • hepatolenticular degeneration (copper accumulation & decrease in ceruloplasmin) Wiskott-Aldrich Syndrome • immunodeficiency: combined B- &T-cell deficiency (thrombocytopenia & eczema) Wolff-Chaikoff Effect • high iodine level (*)’s thyroid hormone synthesis Zenker’s Diverticulum • esophageal; cricopharyngeal muscles above UES Zollinger-Ellison • gastrin-secreting tumor of pancreas (or intestine) * * acid * intractable ulcers Hallmark Findings (and a few odd items mixed in) Adhesive arachnoiditis Caused by bacterial meningitis, leads to obstructive hydrocephalus Albumino-Cytologic Dissociation • Guillain-Barre (markedly increased protein in CSF with only modest increase in cell count) AFP increase Neural tube defects, hepatocellular carcinoma, yolk sac and embryonal carcinoma AFP decrease Down’s Amnion nodosum Renal agenesis Amyloid in thyroid Thyroid medullary carcinoma (calcitonin) Analgesic abuse Papillary necrosis, esp. in diabetics Anasarca Minimal change disease Aneurysmal nodules Polyarteritis nodosa Angiomyolipoma Tuberous sclerosis Anosmia Kallman’s syndrome Anterior vermian atrophy alcoholism Anticentromere antibody Limited scleroderma (CREST) Anti-DNA topoisomerase antibody Diffuse scleroderma Anti-endomysial antibody Celiac sprue Anti-jo antibody polymositis Anti-mitochondrial antibody Primary biliary cirrhosis Antiplatelet Antibodies • idiopathic thrombocytopenic purpura Anti-sacharommyces cervisiae antibody Crohn’s Anti-Smith antibodies Specific for SLE, anti-ribonulceoprotein Anti-smooth muscle antibody Autoimmune hepatitis type I Arachnodactyly • Marfan’s Aschoff Bodies • rheumatic fever Ashleaf spots (skin) Tuberous sclerosis Atypical lymphocytes EBV Auer Rods • acute promyelocytic leukemia (AML type M3) Autosplenectomy • sickle cell anemia Babinski • UMN lesion Bacterial conjuntivitis S. aureus, strep. pneumo, Hemophilus aegyptius Basophilic Stippling of RBCs • lead poisoning Bence Jones Protein • multiple myeloma free light chains (either kappa or lambda) • Waldenstrom’s macroglobinemia Bilateral breast cancer Lobular carcinoma Bilateral renal cell carcinoma Von Hippel-Lindau Birbeck Granules • histiocytosis X (eosinophilic granuloma) Bladder trabeculation BPH Bloody nipple discharge Intraductal papilloma Blueberry muffin baby Rubella Blue Bloater • Chronic Bronchitis Blue Sclera Osteogenesis imperfecta Boot-Shaped Heart • Tetralogy of Fallot Bouchard’s Nodes • osteoarthritis (PIP) Boutonniere’s Deformity • rheumatoid arthritis Bronze Diabetes Hemochromatosis Brown Tumor • hyperparathyroidism Brudzinski sign meningitis Brushfield Spots • Down’s, on iris Call-Exner Bodies • granulosa cell tumor Carbon monoxide poisoning Hyperemia, edema and necrosis of globus Cardiomegaly with Apical Atrophy • Chagas’ Disease Central Nuclei in Muscle Muscular dystrophies Chancre • 1* Syphilis, painless firm ulcers Chancroid • Haemophilus ducreyi, painful soft ulcers Charcot Triad • multiple sclerosis (nystagmus, intention tremor, scanning speech) Charcot-Leyden Crystals • bronchial asthma Cherry-red spot on macula Tay-Sachs, 50% of Niemann-Pick Cheyne-Stokes Breathing • cerebral lesion Chocolate Cysts • endometriosis Cholesterol clefts atherosclerosis Chordae tendinae short and fused Rheumatic heart disease Chronic staph infections Chronic granulomatous disease, a deficiency of NADPH oxidase, can’t kill catalase positive bugs Chvostek’s Sign • Hypocalcemia facial spasm in tetany Clear nuclei Thyroid papillary carcinoma (Orphan Annie’s eyes) Clue Cells • Gardnerella vaginitis Codman’s Triangle • osteosarcoma Coin Lesions in Lung Pulmonary Hamartoma Cold Agglutinins • Mycoplasma pneumoniae • infectious mononucleosis Cold thyroid nodules Colloid cyst or thyroid adenoma Concentric laminar intimal fibrosis of small arteries of lung Primary pulmonary hypertension Condyloma Lata • 2* Syphilis • new coffee flavor at Bagel & Bagel Congenital Hepatic Fibrosis Polycystic Kidney Disease, juvenile autosomal recessive form Contraction Band Necrosis MI Cotton Wool Spots • HTN Councilman Bodies • dying hepatocytes Crescents In Bowman’s Capsule • rapidly progressive (crescentic glomerulonephritis) Crushed ping pong balls Pneumocystis carinii Crypt abscesses Ulcerative colitis Currant-Jelly Sputum • Klebsiella Curschmann’s Spirals • bronchial asthma Cystathioine synthase deficieny homocystinuria D-dimers DIC Depigmentation Of Substantia Nigra • Parkinson’s Dew drop on rose petal Chicken pox Diaphragmatic pleural plaques Asbestosis Donovan Bodies • granuloma inguinale (STD) Double bubble sign on ultrasound Down’s syndorme – duodenal atresia Duret Hemorrhages Uncal herniation Eburnation • osteoarthritis (polished, ivory-like appearance of bone) Eccentric intimal fibrosis with medial hypertrophy Chronic transplant rejection Ectopia Lentis • Marfan’s Embolizing endocarditis Infectious, marantic (fibrin deposits in hypercoagulable states) Erythema Chronicum Migrans • Lyme Disease Excavation of Optic Cup Glaucoma Exopthalmos hyperthyroid FAT RN TTP (fever, anemia, thrombocytopenia, renal failure, neuro problems) Fatty Liver • Alcoholism Fecalith Acute appendicitis False positive VDRL SLE, Treponema pertenue (non-STD tropical infection) Ferruginous Bodies • asbestosis Fish-mouthed mitral valve Rheumatic heart disease Flea-bitten Kidney Malignant Hypertension Frontal bossing Sickle cell anemia Fungus ball in lung Apergillus galactosemia Galactose-1phosphate uridyl transferase deficiency or galactokinase deficiency Garlic odor on breath Arsenic (or lasagna) Ghon Complex • Tuberculosis, primary Gold Pneumonia Lipid pneumonia, exogenous (aspiration) or endogenous (obstruction Gower’s Maneuver • Duchenne’s MD use of arms to stand Gray discoloration of skin Argyria (silver poisoning) Hat size increase Paget’s disease of bone Heart Failure Cells CHF; hemosiderin-laden macrophages in lungs Heberden’s Nodes • Osteoarthritis (DIP) Heinz Bodies • G6PDH Deficiency Hemarthrosis Coagulation factor deficiency Hemorrhagic Temporal Lobe Lesion HSV Hemorrhagic Urticaria • HenochSchonlein Heterophil Antibodies • infectious mononucleosis (EBV) Hirano Bodies • Alzheimer’s HLA B27 Ankylosing spondylitis ochronosis (dark pigment of fibrous tissue) Alkaptonuria – homogentisic acid oxidase deficiency Honeycomb lung Pulmonary fibrosis Howell Jolley Bodies Splenectomy, remnant of nuclear DNA H shaped vertebrae Sickle cell anemia Human placental lactogen increase Placental site trophoblastic tumor Hyaline thrombi TTP Hydrosalpinx Chronic pelvic inflammatory disease Hypersegmented PMNs • Megaloblastic anemia Hypochromic Microcytic RBCs • irondeficiency anemia IgM against IgG Rheumatoid arthritis (rheumatoid factor) ↓ Immunoglobulins X-linked Brutons agammaglobulinemia, and common variable immunodeficiency Index finger overlapping 3rd and 4th Edward’s (Trisomy 18) Jarisch-Herxheimer Reaction • Syphilis over-aggressive treatment of an asymptomatic pt. that causes symptoms 2° to rapid lysis Joint Mice • osteoarthritis (fractured osteophytes) Kaussmaul Breathing • acidosis Keratin Pearls • SCCA Kernig’s sign meningitis Keyser-Fleischer Ring • Wilson’s Kimmelstiel-Wilson Nodules • diabetic nephropathy Koilocytes • HPV Koplik Spots • measles Lacunar cells Variant of Reed-Sternberg cell seen in nodular sclerosing Hodgkin’s Disease Lacunar infarct Chronic hypertension Lamellar bodies Contain surfactant in Type II pneumocytes Langhans giant cells Tuberculosis, other including coccidioides Lemon yellow skin color Pernicious anemia Lemon sign Ultrasonographic finding in Neural Tube Defects Leukocoria Retinoblastoma Lewy Bodies • Parkinson’s (eosinophilic inclusions in damaged substantia nigra cells) Leukocyte alk. Phos. Positive Leukemoid rxn. Lines of Zahn • arterial thrombus Lisch Nodules • neurofibromatosis (von Recklinhausen’s disease) Loss of grey-white junction Tuberous sclerosis Low set ears Downs, DiGeorge, Trisomy 18 (Edwards) Lumpy-Bumpy IF Glomeruli • poststreptococcal glomerulonephritis Machine-like murmur Patent ductus arteriosus Macronodular cirrhosis Wilson’s, viral hepatitis, alpha-1-antitrypsin Malignant pustule Anthrax (black skin lesion) Mallory Bodies Alcoholic liver disease: intermediate filaments of hepatocyte cytoskeleton Maple syrup/burnt sugar urine Alphaketoacid dehydrogenase deficiency; valine, leucine and isoleucine build up (branched) McBurney’s Sign • appendicitis (McBurney’s Point is 2/3 of the way from the umbilicus to anterior superior iliac spine) Meconium ileus Cystic Fibrosis Mees lines Arsenic (parallel lines on fingernails) Melanosis coli Laxative abuse Mental probs. with heart defect Mitral prolapse Michealis-Gutmann Bodies • Malakoplakia, an abnormal tissue response to kidney infection Microglial nodules HIV Micrognathia DiGeorge Micronodular cirrhosis Wilsons, alcoholic, hemochromatosis, primary biliary cirrhosis Microsatellite instability HNPCC (right-sided colon cancer), but also possible in other cancers Mid-systolic click Mitral prolapse Monoclonal Antibody Spike • multiple myeloma this is called the M protein (usually IgG or IgA) • MGUS Mousy / musty odor PKU Mucosal bleeding Platelet problem (qualitative or quantitative) Myxedema • hypothyroidism Necrolytic migratory erythema dermatitis α -cell islet tumor Negri Bodies and hydrophobia • rabies Neuritic Plaques • Alzheimer’s Neurofibrillary Tangles • Alzheimer’s Night pain relieved by aspirin Osteoid osteoma Non-embolizing endocarditis Rheumatic, Libman-Sacks (with SLE) Non-pitting Edema • Myxedema • Anthrax Toxin Notching of Ribs • Coarctation of Aorta Nutmeg Liver • CHF, right heart Onion skin kidney arterioles Malignant nephrosclerosis (malignant hypertension) Oligoclonal band Multiple sclerosis Osteoid production osteosarcoma Painless Jaundice • pancreatic CA (head) Palatal Petechaie Strep pharyngitis Palpable purpura Hypersensitivity vasculitis (Henoch-Schonlein, serum sickness) Pancarditis Rheumatic fever Pannus • rheumatoid arthritis PAS positive macrophages Whipple’s disease Patent ductus arteriosus Maternal rubella and prematurity Pautrier’s Microabscesses • mycosis fungoides (cutaneous T-cell lymphoma) Periductal edema Gynecomastia Periventricular Calcifications Congenital CMV (brain ventricles, that is) Phenylalanine hydroxylase deficiency PKU Philadelphia Chromosome • CML Pick Bodies • Pick’s Disease Piecemeal Necrosis Chronic active hepatitis (periportal hepatocytes) Plexiform lesions Pulmonary HTN (aneurysmal expansion of vessel wall) Pink, foamy lung exudate Pneumocystis carinii pneumonia Pink Puffer • Emphysema Centroacinar – smoking Panacinar - α 1-antitrypsin deficiency Podagra • gout (MP joint of hallux) Porcelain gallbladder Chronic cholecystitis (scarring) Porcelain gallstones Associated with gallbladder adenocarcinoma Port-Wine Stain • Hemangioma Posterior Anterior Drawer Sign • tearing of the ACL Proliferating bile ducts Obstructive jaundice Psammoma Bodies • Papillary adenocarcinoma of the thyroid • Serous papillary cystadenocarcinoma of the ovary • Meningioma • Mesothelioma Pseudohypertrophy • Duchenne muscular dystrophy Pseudopoyps Ulcerative colitis Pulmonary atherosclerosis Cor pulmonale PunchedOut Bone Lesions • multiple myeloma Punched-out esophageal lesions herpes Rash on Palms & Soles • 2° Syphilis • RMSF RBC poikilocytosis Beta-thalassemia Rectangular RBC’s Hemoglobin SC Red hyalin globules Alpha-1-antitrypsin deficiency (in liver) Red Morning Urine • paroxysmal nocturnal hemoglobinuria ReedSternberg Cells • Hodgkin’s Disease Reid Index Increased • chronic bronchitis Reinke Crystals • Leydig cell tumor Rhomboid crystals Pseudogout Rim pattern SLE, staining pattern with anti-double stranded DNA antibodies Rockerbottom feet Patau (Trisomy 13), Edward’s (Trisomy 18) Rose thorns Sporotrichosis Rouleaux Formation • multiple myeloma RBC’s stacked as poker chips Rugae loss Pernicious anemia (atrophic gastritis) S3 Heart Sound • L→R Shunt (VSD, PDA) • Mitral Regurg • LV Failure S4 Heart Sound • Pulmonary Stenosis • Pulmonary HTN Scalloped colloid Grave’s disease Schwartzman Reaction • Neisseria meningitidis impressive rash with bugs Shagreen patches Tuberous sclerosis Simian Crease • Down’s Smith Antigen • SLE (also anti-dsDNA) Smudge cells CLL (delicate cells easily destroyed on peripheral smear) Soap Bubble on X-Ray • giant cell tumor of bone Soldiers plaque Clinically insignificant remnant of healed pericarditis Spider telangiectasia Hyperestrinism: liver faillure, pregnancy Spike & Dome Glomeruli • membranous glomerulonephritis Splinter hemorrhages Infective endocarditis Strawberry tongue Scarlet fever, Kawasaki’s Strawberry cervix Trichomonas vaginalis Strawberry gallbladder cholesterolosis String Sign on X-ray • Crohn’s bowel wall thickening Sugar icing on spleen Portal hypertension Sulfer granules Collection of actinomyces or nocardia organisms in chronic abscessing bronchopneumonia Swiss cheese brain Clostridia (gas forming) Syncitia RSV, measles Tamm-Horsfall protein Hyaline casts (non-specific) Target Cells • Thalassemia Teardrop RBCs Myelofibrosis Temporal lobe encephalitis Herpes Tendinous Xanthomas • Familial Hypercholesterolemia Tethered cord Arnold-Chiari malformation (tonsilar herniation) Tetrahydrobiopterin cofactor def. PKU Thymidine dimers Xeroderma pigmentosum Thymus, parathyroid agenesis Digeorge (3rd and 4th pharyngeal pouch) Thyroidization of Kidney • chronic pyelonephritis TIBC increase Anemia of chronic disease Tingible Bodies Macrophage in lymph node germinal centers Tophi • gout Tram-Track Glomeruli • membranoproliferative glomerulonephritis Tree bark aorta Syphilis Trousseau’s Sign • visceral ca, classically pancreatic (migratory thrombophlebitis) • hypocalcemia (carpal spasm) These are two entirely different disease processes and different signs, but they unfortunately have the same name. TSI > TGI Grave’s TGI > TSI Hashimoto’s Tyrosinase deficiency Albinism Virchow’s Node • supraclavicular node enlargement by metastatic carcinoma of the stomach VMA and metenephrins in urine Pheochromocytoma Warthin-Finkeldey Giant Cells • Measles Waterhammer pulse Aortic regurgitation WBC Casts • pyelonephritis White matter petechaie Fat emboli Winged scapula Long thoracic nerve (C5,6,7) damage, common with radical mastectomy Wire Loop Glomeruli • lupus nephropathy, type IV Wrinkled glomerular basement membrane ischemia ↑ AFP in amniotic fluid or mother’s serum • Spina Bifida • Anencephaly ↑ Uric Acid • Gout • Lesch Nyhan • Myeloproliferative Disorders • Diuretics (Loop & Thiazides) ↓ FEV1/FVC • COPD ↓ glucose, ↑ protein in CSF Bacterial meningitis ↑ dopamine receptors Schizophrenia ↓ dopamine receptors Parkinson’s Most Common… 1° Tumor arising from bone in adults • Multiple Myeloma Adrenal Medullary Tumor – Adults • Pheochromocytoma Adrenal Medullary Tumor – Children • Neuroblastoma Arteries of stroke Lateral striate Bacterial Meningitis – adults • Neisseria meningitidis Bacterial Meningitis – elderly • Strep pneumoniae Bacterial Meningitis – newborns • E. coli Bacterial Meningitis – toddlers • Hib B cell defect (genetic) Isolated IgA deficiency Bone Tumors • Metasteses from Breast & Prostate Brain Tumor – Child • Medulloblastoma (cerebellum) Brain Tumor –Adult • Astrocytoma (including Glioblastoma Multiforme) then: mets, meningioma, Schwannoma Breast Carcinoma • Invasive Duct Carcinoma Breast Mass • Fibrocystic Change (Carcinoma is the most common is postmenopausal women) Bug in Acute Endocarditis • Staph aureus Bug in debilitated, hospitalized pneumonia pt • Klebsiella Bug in Epiglottitis • Hib Bug in GI Tract • Bacteroides (2nd – E. coli) Bug in IV drug user bacteremia / pneumonia • Staph aureus Bug in PID • N. Gonnorrhoeae Bug in Subacute Endocarditis • Strep Viridans Cardiac 1° Tumor – Adults • Myxoma “Ball Valve” Cardiac 1° Tumor – Child • Rhabdomyoma Cardiac Tumor – Adults • Metasteses Cardiomyopathy • Dilated (Congestive) Cardiomyopathy Carpal bone fractured scaphoid Cause of 2° HTN • Renal Disease Cause of Addison’s • Autoimmune (2nd – infection) Cause of Congenital Adrenal Hyperplasia • 21-Hydroxylase Deficiency (then, 11-) Cause of Cushings • Exogenous Steroid Therapy (then, 1° ↑ ACTH, Adrenal Adenoma, Ectopic ACTH) Cause of death in Alzheimer pts • Pneumonia Cause of death in amyloidosis Chronic renal failure Cause of death in Diabetics • MI Cause of Death in SLE pts. • Lupus Nephropathy Type IV (Diffuse Proliferative) Cause of Dementia • Alzheimer’s Cause of Dementia (2nd most common) • Multi-Infarct Dementia Cause of food poisoning • Staph aureus Cause of mental retardation • Down’s Cause of mental retardation (2nd most common) • Fragile X Cause of preventable blindness • Chlamydia Cause of Pulmonary HTN • COPD Cause of SIADH • Small Cell Carcinoma of the Lung Chromosomal disorder • Down’s Congenital cardiac anomaly • VSD (membranous > muscular) Congenital early cyanosis • Tetralogy of Fallot Coronary Artery thrombosis • LAD Demyelinating Disease • Multiple Sclerosis Dietary Deficiency • Iron Disseminated opportunistic infection in AIDS • CMV (Pneumocystis carinii is most common overall) Esophageal cancer • SCCA Fatal genetic defect in Caucasians • Cystic Fibrosis Female Tumor • Leimyoma Form of Amyloidosis • Immunologic (Bence Jones protein in multiple myeloma is also called the Amyloid Light Chain) Form of Tularemia • Ulceroglandular Gynecologic malignancy • Endometrial Carcinoma Heart Murmur • Mitral Valve Prolapse Heart problem in AIDS Pericarditis Heart tumor in adults myxoma Heart tumor in kids rhabdomyoma Heart Valve in bacterial endocarditis • Mitral Heart Valve in bacterial endocarditis in IV drug users • Tricuspid Heart Valve involved in Rheumatic Fever • Mitral then Aortic Hereditary Bleeding Disorder • Von Willebrand’s Disease Liver 1° Tumor • Hepatoma, seen in women on oral contraceptives Liver Disease • Alcoholic Liver Disease Location of Adult brain tumors • Above Tentorium Location of Childhood brain tumors • Below Tentorium Location of GI tuberculosis Ileocecal Lysosomal Storage Disease • Gaucher’s Motor Neuron Disease • ALS Myocarditis cause Coxsackie B Neoplasm – Child • Leukemia Neoplasm – Child (2nd most common) • Medulloblastoma of brain (cerebellum) Nephrotic Syndrome • Membranous Glomerulonephritis Opportunistic infection in AIDS • PCP Osteomyelitis in IV drug user Pseudomonas Osteomyelitis in sickle cell Salmonella Ovarian Malignancy • Serous Cystadenoma Ovarian Tumor • Hamartoma Pancreatic Tumor • Adeno (usually in the head) Patient with ALL / CLL / AML / CML • ALL - Child / CLL - Adult over 60 / AML - Adult over 60 / CML - Adult 35-50 Patient with Goodpasture’s • Young male Patient with Reiter’s • Male Pituitary Tumor • Prolactinoma (2nd – Somatotropic “Acidophilic” Adenoma) Primary Hyperparathyroidism • Adenomas (followed by: hyperplasia, then carcinoma) Pt. With Hodgkin’s • Young Male (except Nodular Sclerosis type – Female) Pt. With Minimal Change Disease • Young Child Secondary Hyperparathyroidism • Hypocalcemia of Chronic Renal Failure Sexually transmitted disease • Chlamydia Site of Diverticula • Sigmoid Colon Site of metastasis • Regional Lymph Nodes Site of metastasis (2nd most common) • Liver Sites of atherosclerosis • Abdominal aorta > coronary > popliteal > carotid Skin Cancer • Basal Cell Carcinoma Stomach cancer • Adeno Testicular Tumor • Seminoma Thyroid Cancer • Papillary Carcinoma Tracheoesophageal Fistula • Lower esophagus joins trachea / upper esophagus – blind pouch Tumor of Infancy • Hemangioma Type of Hodkin’s • Mixed Cellularity (versus: lymphocytic predominance, lymphocytic depletion, nodular sclerosis) Type of Non-Hodgkin’s • Follicular, small cleaved Vasculitis (of medium & small arteries) • Temporal Arteritis Viral Encephalitis • HSV Worm infection in US • Pinworm (2nd – Ascaris) Signature Drug Toxicities Agranulocytosis • Clozapine Aplastic Anemia • Chloramphenicol • NSAIDs • Benzene Arrhythmia Tricyclic antidepressant (wide QRS) Cardiac glycosides, especially with hypokalemia Atropine-like Side Effects • Tricyclics Blindness Methanol (Formic Acid) Cardiotoxicity • Doxorubicin • Daunorubicin Cartilage Damage in children • Fluoroquinolones (Ciprofloxacin & Norfloxacin) Cinchonism • Quinidine Cough • ACE Inhibitors Diabetes Insipidus • Lithium Disulfiram-like effect • Metronidazole • Sulfonylureas (1st generation) Extrapyramidal Side Effects • Antipsychotics (Thioridazine, Haloperidol, Chlorpromazine) Fanconi’s Syndrome • Tetracycline Fatal Hepatotoxicity (necrosis) • Valproic Acid • Halothane • Acetaminophen Gingical Hyperplasia • Phenytoin Gray Baby Syndrome • Chloramphenicol Gynecomastia • Cimetidine • Azoles • Spironolactone • Digitalis Hemolytic Anemia in G6PDdeficiency • Sulfonamides • Isoniazid • Aspirin • Ibuprofen • Primaquine Hepatitis • Isoniazid Hepatocellular carcinoma Polyvinyl chloride, anaphylatoxins Hot Flashes, Flushing • Niacin • Tamoxifen • Ca++ Channel Blockers Induce CP450 • Barbiturates • Phenytoin • Carbamazepine • Rifampin Inhibit CP450 • Cimetidine • Ketoconazole Interstitial Nephritis • Methicillin • NSAIDs (except Aspirin) • Furosemide • Sulfonamides Lupus like Procainamide, hydralazine Malignant hyperthermia Succinyl choline, halothane Monday Disease • Nitroglycerin Industrial exposure → tolerance during week → loss of tolerance during weekend → headache, tach, dizziness upon re-exposure Neuroleptic malignant syndrome Haloperidol Orange Body Fluids • Rifampin Osteoporosis • Heparin • Corticosteroids Positive Coombs’ Test • Methyldopa Pulmonary Fibrosis • Bleomycin • Amiodarone Red Man Syndrome • Vancomycin Severe HTN with Tyramine • MAOIs SLE-like Syndrome • Procainamide • Hydralazine Tardive Dyskinesia • Antipsychotics (Thioridazine, Haloperidol, Chlorpromazine) Tinnitus • Aspirin • Quinidine Torsade de pointes Quinidine Vaginal Adenosis and Clear Cell Carcinoma DES Miscellaneous • Fastest growing tumor – Burkitt’s • PE’s are found in half of all autopsies • Courvoisier’s Law: tumors that obstruct the common bile duct cause enlarged gallbladders, but obstructing gallstones do not (too much scarring). • Only DNA virus to replicate in cytoplasm: Pox • Only RNA virus to replicate in nucleus: Influenza • Bacillus anthracis has the only protein capsule • Bordetella pertussis (Whooping Cough) elicits lymphocytosis rather than granulocytosis • Bronchioalveolar carcinomas grow without destroying the normal architecture of the lung • Cryptococcus neoformans often lacks a capsule and, when stained with GMS, looks just like Pneumycistis carinii, except that Cryptococcus lacks the prominent nucleoli. Alcohol abuse screening questions CAGE: 1. Ever felt it necessary to Cut down on drinking? 2. Has anyone ever said they felt Annoyed by your drinking? 3. Ever felt Guilty about drinking? 4 Ever felt a need to have a morning drink as an Eye opener? Abdominal swelling causes 5 F’s: Fat Feces Fluid Flatus Fetus Full-sized tumors Patient examination organization SOAP: Subjective: what the patient says. Objective: what the examiner observes. Assessment: what the examiner thinks is going on. Plan: what they intend to do about it. Vomiting: non-GIT differential ABCDEFGHI: Acute renal failure Brain [increased ICP] Cardiac [inferior MI] DKA Ears [labyrinthitis] Foreign substances [Tylenol, theo, etc.] Glaucoma Hyperemesis gravidarum Infection [pyelonephritis, meningitis] History: quick EMS medical history checklist SAMPLE: Signs/ Symptoms Allergies Medications Pertinent history Last oral intake Events preceding this incident Pain history checklist OPQRSTU: Onset of pain (time, duration) Palliative factors for pain Quality of pain (throbbing, stabbing, dull, etc.) Region of body affected Severity of pain (usually scale of 1-10) Timing of pain (after exercise, in evening, etc.) U: How does it affect ‘U’ in your daily life? · May wish to expand to OPPQRRSTTUVW, with the extra letters representing: Provocative factors Radiation (how does pain spread) Treatments tried Deja Vu: Has this happened before? Worry: What do you think or fear that it is? Differential diagnosis checklist “A VITAMIN C” A and C stand for Acquired and Congenital · VITAMIN stands for: Vascular Inflammatory (Infectious and non-Infectious) Trauma/ Toxins Autoimmune Metabolic Idiopathic Neoplastic · Example usage: List causes of decreased vision: Central retinal artery occlusion, Retinitis pigmentosa, Perforation to gobe, Chronic Gentamycin use, Ruematoid arthritis, Diabetes, Idiopathic, Any eye tumor, Myopia. Sign vs. symptoms Ign: something I can detect even if patient is unconscious. sYMptom is something only hYM knows about. Eyes: abbreviations for the eyes You look OUt with Both eyes. Take the Right dose so you won’t OD [overdose]. The only one that is Left is OS. · Both eyes=OU, Right eye=OD, Left eye=OS. Medical history: disease checklist MJ THREADS: Myocardial infarction Jaundice Tuberculosis Hypertension Rheumatic fever/ Rheumatoid arthritis Epilepsy Asthma Diabetes Strokes Pain history checklist “On Days Feeling Low Character, Run A Seven Pace Race”: Onset Duration Frequency Location Character Radiation Severity Precipitating factors Relieving factors Pain history checklist ASK LAST: Aggravating/ Alleviating Severity Karacter Location Associated symptoms Setting Timing Pain history checklist SOCRATES: Site Onset Character Radiation Alleviating factors/ Associated symptoms Timing (duration, frequency) Exacerbating factors Severity · Alternatively, Signs and Symptoms with the ‘S’. Symptom attributes “FAST LQQ’S”: Factors that make it better/worse Associated manifestations Setting Timing Location Quality Quantity Severity Heart valve auscultation sites “All Patients Take Meds”: · Reading from top left: Aortic Pulmonary Tricuspid Mitral · See diagram. · Alternatively: All Prostitutes Take Money. · Alternatively: APe To Man. Four point physical assessment of a disease “I’m A People Person”: Inspection Auscultation Percussion Palpation Physical exam for ‘lumps and bumps’ “6 Students and 3 Teachers go for CAMPFIRE”: Site, Size, Shape, Surface, Skin, Scar Tenderness, Temperature, Transillumination Consistency Attachment Mobility Pulsation Fluctuation Irreducibility Regional lymph nodes Edge Surgical sieve VANISHED: Vascular Accident & trauma Neoplastic Inflammatory Septic Haematologic/ Hereditary Endocrinological Degenerative Differential diagnosis checklist “I VINDICATE”: Iatrogenic Vascular Infectious Neoplastic Degenerative/ Drugs Inflammatory/ Idiopathic Congenital Allergic/ Autoimmune Traumatic Endocrinal & metabolic Symptom sieve “TIN CAN BED DIP POG”: Trauma Infection Neoplasm Cardiac Autoimmune Neurological Blood/ Bone Endocrine Disintegration/ Degeneration Drugs Iatrogenic/ Idiopathic Psychological Paediatric Obstetric Gynaecological Pain history checklist LOST WAR: Location Onset Severity Time Worsening factors Alleviating factors Radiation Short statue causes RETARD HEIGHT: Rickets Endocrine (cretinism, hypopituitarism, Cushing’s) Turner syndrome Achondroplasia Respiratory (suppurative lung disease) Down syndrome Hereditary Environmental (postirradiation, postinfectious) IUGR GI (malabsorption) Heart (congenital heart disease) Tilted backbone (scoliosis) Ascultation: crackles (rales )”PEBbles”: Pneumonia Edema of lung Bronchitis Pain history checklist CHLORIDE: Character (stabbing, throbbing, etc.) Location Onset Radiation Intensity Duration Events (associated with, or palliative and provocative factors) Differential diagnosis CIMETIDINE: Congenital Infection/ Inflammatory Metabolic Endocrine Trauma Iatrogenic Degenerative Idiopathic Neoplastic Everything else Sign vs. symptom Remember Ace of Base’s song that goes like this: “I Saw the Sign, and it opened up my eyes”. The physician sees the signs. Systems review: systems checklist I PUNCH EAR: Integumental Pulmonary Urogenital Nervous Cardiovascular Hematolymphoid Endocrine Alimentary Reproductive Pain history checklist MR. C T FARADS: Main site Radiation Character Timing Frequency Associated factors Relieving factors Aggravating factors Duration Severity Abdomen assessment To assess abdomen, palpate all 4 quadrants for DR. GERM: Distension: liver problems, bowel obstruction Rigidity (board like): bleeding Guarding: muscular tension when touched Eviseration/ Ecchymosis Rebound tenderness: infection Masses Pain history checklist CLITORIS: Character Location Intensity Timing Onset Radiating Irritating and relieving factors Symptoms associated Past medical history (PMH) VAMP THIS: Vices (tobacco, alcohol, other drugs, sexual risks) Allergies Medications Preexisting medical conditions Trauma Hospitalizations Immunizations Surgeries Patient profile (PP) LADDERS: Living situation/ Lifestyle Anxiety Depression Daily activities (describe a typical day) Environmental risks/ Exposure Relationships Support system/ Stress Family history (FH) BALD CHASM: Blood pressure (high) Arthritis Lung disease Diabetes Cancer Heart disease Alcoholism Stroke Mental health disorders (depression, etc.) Differential diagnosis checklist DIRECTION: Drugs Infection Rheumatologic Endocrine Cardiovascular Trauma Inflammatory Other Neoplasm Pathologic classification NIT DIT FIT: Neoplastic Infectious Traumatic Degenerative/ Drugs Immune Toxic Vascular Inflammatory Totally obscure Pyrexia of Unknown Origin: history taking SIT ON FRAD: Sexual history Immunisation status Travel history Occupational history Nutrition (consumption of dairy products, etc.) Family history Recreational habits Animal contacts (including ticks and other vectors) Drug history Health related behavior (HRB) topics: history taking “Healthy SEEDS”: Substances (alcohol, tobacco, IV drugs?) Environment (hazards at home or work? feel safe?) Exercise (what do you do? how often do you do it?) Diet (any special diet?) Sex (active with m/f/both? >1 partner? safe sex? STD history? difficulty with arousal or orgasm? history of abuse?) · I find this order works well: patients most expect to be asked about alcohol and they least want to talk about their STD history, but taking a solid HRB history first reassures them that it’s all part of good medical care. Breast history checklist LMNOP: Lump Mammary changes Nipple changes Other symptoms Patient risk factors Pain history checklist COLDER BARS: Character Onset Location Duration Exacerbating factors Radiation Before (ever happened before) Associated symptoms Relieving factors Severity Pain history checklist SO CRAP: Site Onset Character Radiates to Associated symptoms/ Alleviating and exacerbating factors Periodicity History, HCFA components for E+M coding Q LSD MCAT: Quality Location Severity Duration Modifying factors Context Associated signs and symptoms Timing Surgical sieve for diagnostic categories INVESTIGATIONS: Iatrogenic Neoplastic Vascular Endocrine Structural/ Mechanical Traumatic Inflammatory Genetic/ Congenital Autoimmune Toxic Infective Old age/ Degenerative Nutritional Spontaneous/ Idiopathic Mental state examination: stages in order “Assessed Mental State To Be Positively Clinically Unremarkable”: Appearance and behaviour [observe state, clothing...] Mood [recent spirit] Speech [rate, form, content] Thinking [thoughts, perceptions] Behavioural abnormalities Perception abnormalities Cognition [time, place, age...] Understanding of condition [ideas, expectations, concerns] Branham sign: definition BRAnham sign: BRAdycardia after compression or excision of a large AV fistula. Glasgow coma scale: components and numbers · Scale types is 3 V’s: Visual response Verbal response Vibratory (motor) response · Scale scores are 4,5,6: Scale of 4: see so much more Scale of 5: talking jive Scale of 6: feels the pricks (if testing motor by pain withdrawl) Meckel’s diverticulum- rule of 2’s 2 inches long, 2 feet from the ileocecal valve, 2% of the population commonlly presents in the first 2 years of life may contain 2 types of epithelial tissue Pheochromocytoma-rule of 10s: 10% malignant 10% Bilateral 10% extraadrenal 10% calcified 10% children 10% familial * discussed 10 times more often than actually seen Aphasia “BROKen aphasia” (Broca’s aphasia-broken speech) “Wordys aphasia” (Wernicke’s aphasia- wordy, but making no sense) GET SMASH’D—Causes of Acute pancreatitis Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune(PAN), Scorpion bites, Hyperlipidemia, Drugs(azathioprine, diuretics) (Multiple endocrine neoplasia) Each of the MENs is a disease of three or two letters plus a feature. “MEN I” is a disease of the 3 Ps (pituitary, parathyroid and pancreas) plus adrenal cortex. “MEN II “ is a disease of the two Cs (carcinoma of the thyroid and catacholamines [pheochromocytoma]) plus parathyroid for MEN IIa or mucocutaneous neuromas for MEN IIb (aka MEN III). Acute pneumonia caused by Pyogenic bacteria—PMN infiltrate Acute pneumonia caused by Miscellaneous microbes—Mononuclear infiltrate Takayasu’s diz = pulseless diz, therefore when you have Takayasu’s, I can’t Tak’a yu pulse. Argyll-Robertson Pupil—syphilitic pupil (AKA “Prostitute’s pupil” Accommodates, but doesn’t react ) Accommodation reflex present, Pupillary reflex absent CAGE—alcohol use screening 1. Have you ever felt it necessary to CUT DOWN on your drinking? 2. Has anyone ever told you they were ANNOYED by your drinking? 3. Have you ever felt GUILTY about your drinking? 4. Have you ever felt the need to have a drink in the morning for an EYE OPENER? P-Q-R-S-T—eliciting and HPI and exploring symptoms P—palliative or provocative factors for the pain Q—quality of pain(burning, stabbing, aching, etc.) R—region of body affected S—severity of pain(usually 1-10 scale) T—timing of pain(eg.-after meals, in the morning, etc.) The five W’s—post-operative fever Wind—pneumonia, atelectasis Water—urinary tract infection Wound—wound infections Wonderdrugs—especially anesthesia Walking—walking can help reduce deep vein thromboses and pulmonary embolus ACID or “Anna Cycled Immediately Downhill” classification of hypersensitivity reactions Type I - Anaphylaxis Type II - Cytotoxic-mediated Type III - Immune-complex Type IV - Delayed hypersensitivity WBC Count: “Never Let Momma Eat Beans(60, 30, 6, 3, 1) Neutrophils 60% Lymphocytes 30% Monocytes 6% Eosinophils 3% Basophils 1% A-P-G-A-R: A - appearance (color) P - pulse (heart rate) G - grimmace (reflex, irritability) A - activity (muscle tone) R - respiratory effort 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 The 4 P’s of arterial Occlusion: pain pallor pulselessness paresthesias The 4 T’s of Anterior Mediastinal Mass:Thyroid tumor,Thymoma,Teratoma, Terrible Lymphoma Back to ValueMD Medical Mnemonics Home