1. internal medicine MEMORY AID FOR INTERNAL MEDICINE 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 )
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1. internal medicine
MEMORY AID FOR INTERNAL MEDICINE
Causes of acute Pancreatitis
BAD SHIT
Black scorpion biteAlcohol ( or autoimmune : PAN )Drugs ( tetracycline, azothioprin, sulfa, diuretics )
Stones ( gallstones or steroid )HyperlipidemiaInfection ( mumps )Trauma
If QRS complex is wide, consider bundle branch block. LBBB causes a "W" pattern in V1-2 and a "M" pattern in V5-6. RBBB is the other way round. Remember as WiLLiaM MaRRoW.
-The mnemonic key is Arthur Shawcross (AS), a cannibalistic murderer, a key which immediatelyfollows the symbol.
-Clinical:
Angina pectoris despite normal coronary arteriesArthur Shawcross represents the Angel of death [Angina].
Exertional syncope His victims Swooned [Syncope] with fear when they saw him.
Exertional dyspnea of congestive heart failureArthur 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 increasedleft 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 wasDelayed [upstroke], and, it soon became too Little, too Late [Parvus et Tardus].
Paradoxical splitting of S2AS sent his victims to Paradise [Paradoxical].
References:1. Harrison Principles of Internal Medicine, 14/e Edition, McGraw-Hill, New York, 1998.2. Maximum access to diagnosis and therapy (MAXX), Lippincott Williams & Wilkins, New York, 1999
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.
H: History of any pulmonary diseaseA: Activity at onsetP: Pain upon inspirationI: Infections fever/chillsS: Smoker years/packsO: OrthopneaC: Cough (Persistent)S: Sputum Productive/color
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.
ACE - Angiotensin converting enzyme levels monitor disease activity and response to therapy.
Schaumann's bodies (inclusions)
B-Bell's palsy, Bilateral hilar lymphadenopathy, Black femalesO-Optic nerve dysfunction is a common manifestation of neurosarcoid.E-Eyes: uveitisK-Kveim skin test
S-SulfonylureasA-Adrenal insufficiencyU-Under 0.3 (insulin/glucose ratio) to make the diagnosisC-C-peptide measurement to rule out factitious hypoglycemiaE-Endocrine: Epinephrine, glucagon deficiencies (counterregulatory hormone deficiencies)
I-Immune disease with insulin or insulin receptor antibodiesS-Sarcomas: large retroperitoneal sarcomas
M-Maple syrup urine disease, severe MalariaS-Salicylates in childrenG-Galactosemia (with milk ingestion), disorders of Gluconeogenesis
Remember the following mnemonic when evaluating patients for hyperthyroidism: S : SweatingT : Tremor or TachycardiaI : Intolerance to heat, Irregular menstruation, and IrritabilityN : NervousnessG : Goiter and Gastrointestinal (loose stools/diarrhea). Submitted by Jed
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).
These appear at 2, 4, 6, 8, 10, and 12 years of age in order and go away two years later. The other mnemonic I know for the ossification centers is "Come Rub My Tree Of Love" where the "M" is medial epicondyle and the "L" is the lateral epicondyle.
NEPHROTIC SYNDROME (NS) is characterized by the following: [By Shweta]
N = Na + water retention This occurs due to several factors, including compensatory secretion of aldosterone in response to hypovolemia-mediated release of ADH.
E = EdemaDue to hypoproteinemia + Na, water retention. Edema is soft, pitting and starts in the
periorbital region.
P = Proteinuria >3.5gm/1.74sq. ml/24hrs
H = Hypertension + hyperlipidemia (due to increased lipoprotein synthesis in liver, abnormal transport of circulating lipoproteins, decreased catabolism.)
R = Renal vein thrombosis
O = "Oval fat bodies" in the urine. Lipiduria follows hyperlipidemia. Albumin as well as lipoproteins are lost. Lipoproteins are reabsorbed by tubular epithelial cells and they shed along with degenerated cells- this appears as "oval fat bodies" in urine.
T = Thrombotic + thromboembolic complications owing to loss of anticoagulant factors (eg. anti-thrombin III )
I = Infection. These patients are prone to infection, especially with staphylococci and pneumococci. Vulnerability is due to loss of immunoglobulins.
Autosomal dominant polycystic kidney disease (ADPKD) is associated with cysts in the kidneys and, in many cases, in the brain (berry aneurysms), liver, spleen, pancreas, and lungs.
¡°Halley Berry AKA Dorothy (Dandridge) Portrayed Carmen Jones.¡±
Halley ?Hematuria: Gross and microscopicBerry -Berry aneurysms
AKA ?ADPKD
D-Dominant (autosomal) inheritanceO-Obstruction of the urinary tract by stones, blood clotsR-Renal failureO-Oxalate: calcium oxalate and uric acid stonesT-renal Tubular defectsH-Hemorrhagic cystsY-Year 1 - Most cases are diagnosed in the first year of life, presenting as bilateral abdominal masses.
Portrayed ?Polycystic: continued enlargement of the cysts often leads to progressive renal failure.
Carmen ?CT scanning: Enlarged kidneys with multiple bilateral cysts are diagnosed using ultrasound, IVP,
or CT scanning.Jones - Juvenile nephronophthisis (JN) and medullary cystic disease (MCD) are in the DDx.
-Cardiac valvular disorders: Mostly mitral valve prolapse (MVP) and aortic regurgitation-Salt-wasting nephropathy, renal tubular acidosis (RTA)-Chronic flank pain due to the mass effect of the enlarged kidneys
Lusty Carmen Jones powdered her nose, using her Bivalve [MVP] mirror compact, ¡¦-then she slowly raised her Salt-rimmed [Salt-wasting nephropathy] MargaRiTA [RTA], and seductively placed her other hand on her Hip [Flank pain].
It was said that Dorothy was not allowed to swim in the hotels Chlorinated pool [Hyperchloremic acidosis]. When she defiantly swam in the pool, they Drained it [Salt-wasting nephropathy, Hyponatremia].
-Hypertension-End-stage renal disease (ESRD)
Dorothy was forced to enter through the back door, even while she was contracted to sing under The Big Tent [Hypertension].Dorothy was only 41 when she was found DEAD [ESRD].
Review:
Dx: Positive family history (autosomal dominant inheritance)Gross and microscopic hematuriaUltrasound, IVP, or CT scanning detect the enlarged kidneys with multiple bilateral cysts
References:
1. Harrison Principles of Internal Medicine, 14/e Edition, McGraw-Hill, New York, 1998.2. Bennett WM and Rose BD. Polycystic kidney disease, UpToDate v8.2, (Rose, BD, ed), UpToDate, Inc, Wellesley, MA, 2000.
Vitamin K-dependent proteins and warfarin sodium [by Sung Kim and S. Levine, MD, PhD.]
Warfarin sodium is a vitamin K antagonist.
-Vitamin K-dependent proteins C and S.-Vitamin K-dependent clotting factors II, VII, IX, and X of the extrinsic pathway.
--> The Korean [vitamin K] War [Warfarin] was fought Outdoors [Extrinsic pathway].--> The American PT boats [PT, Protime, or prothrombin time], whose access had been limitedby the rough Seas [protein C], quickly sent out SOS [protein S] messages.
Thalassemia major is the most Severe (c)-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]
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 hemochromatosisA-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 anemiaD-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 lifeI-Intermedia - Beta-thalassemia intermedia presents with abnormalities similar to those of thalassemia major.
Increased susceptibility to infections
Peripheral blood smear: Basophilic stippling Helmet cells Nucleated target cells Anisocytosis (RBCs of different size/volume)
X-ray: Hair-on-end skull
Serum hemoglobin electrophoresis: HbA is decreased.HbA2 is increased.HbF is increased
--> Dr. Cooley performed Major surgery [thalassemia Major] as a Cardiothoracic surgeon [Cardiac failure] live on the Internet [Infections].
--> His skilled hands can perform Microsurgery [Microcytic hypochromic anemia] on Fetuses [HbF].
--> His surgical cap [Helmet cells] fit loosely over his Crew cut [Hair-on-end skull].
--> He proceeded to make an incision along the Blue Stippled line [Basophilic Stippling] drawn on the skin.
--> Dr. Cooley's Target [Target cells] academic score had always been an A+ [HbA2 is increased].
--> He would Not accept a simple A [HbA is decreased].
--> The surgical staff is a close knit community, like a B-A-D M-A-F-I-A (see below), quick to
dispose of weak, Ineffective [Ineffective erythropoiesis] residency candidates.
Characteristic features of multiple myeloma on X-ray are ABCDE - Asymmetry, Border irregular, Colour irregular, Diameter usually > 0.5cm, Elevation irregular.
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>Females50-70 years of age
Songwriter Phil CoLLins [CLL] is Male and probably over 50 years of age. He recently won anOscar 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, hepatomegalyLow serum immunoglobulins (immunosuppression)
--> where the Splendid [Splenomegaly] Moonlight [imMunosuppression] streams through thebranches.
Diffuse bone marrow infiltration and replacement of cellular elements cause: AnemiaThrombocytopeniaGranulocytopenia
--> 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.
--> An African jungle [Autoimmune extravascular] APE [AHA] had Warmly [Warm-antibody]adopted baby Tarzan.
Differential diagnosis
Malignant lymphomaInfectious 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 prednisoneFludarabine
--> Some may imagine a Ram [ChloRambucil] scrambling about, but others will¡¦
--> recall that Clayton [Chlorambucil] is the villainous jungle guide who was hired byProfessor [Prednisone] Porter, not knowing that¡¦
--> ¡¦Clayton [Chlorambucil] had his captured Prey [Prednisone] immediately Flown[Fludarabine] out for profit.
References:
1. Harrison's Principles of Internal Medicine, 14/e Edition, McGraw-Hill, New York, 1998.2. Maximum access to diagnosis and therapy (MAXX), Lippincott Williams & Wilkins, New York, 1999.3. Scientific American Medicine (SAM-CD), Scientific American Inc, New York, 1997.
-The mnemonic key for multiple myeloma (MM) is Marilyn Monroe (MM), a key which immediately followsthe >> 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 foran Oscar award [Osteoporosis].
Susceptibility to bacterial infections.>> MM was Susceptible to Toxic [infections] relationships.
Acute renal failure (ARF) due to the effects of filtered light-chain proteins, hypercalcemia, and amyloid deposits in the kidney. >> MM's Lightly-Chained ARF dog barked when MM's death was said to be related to her JFK Army-Lord [Amyloid].
-Laboratory
Hypercalcemia
>> MM fluffed White Talcum [hypercalcemia] powder on her delicate white skin...
Hypergammaglobulinemia
>> ...to protect it from the movie industry's Large hot Camera lights[hyperGammaglob].
Serum electrolytes: Low anion gap>> MM wore gowns with Low [Low anion gap] revealing necklines.
Rouleaux on peripheral blood smear. Occasionally Coombs(+) hemolytic anemia.
>> MM used hair Rollers [Rouleaux] and Combs [Coombs] to create her famous hairdo.
Leukocyte alkaline phosphatase (LAP) staining reaction: High LAP score.
>> MM used her Great LAP to her advantage because....
Normal levels of Serum Alkaline Phosphatase (SAP)
>> ...she was Not a SAP.
References:1. Harrison's Principles of Internal Medicine, 14/e Edition, McGraw-Hill, New York, 1998.2. Maximum access to diagnosis and therapy (MAXX), Lippincott Williams & Wilkins, New York, 1999.3. Scientific American Medicine (SAM-CD), Scientific American Inc, New York, 1997.
SIADH: Syndrome of inappropriate antidiuretic hormone secretionSCLC: Small cell lung cancerNHL: non-Hodgkin's lymphoma
References:1. UpToDate v8.2, (Rose, BD, ed), UpToDate, Inc, Wellesley, MA, 2000.2. Scientific American Medicine (SAM-CD), Scientific American Inc, New York, 1997.
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)
S-Sentinel headache that precedes a major subarachnoid hemorrhage (SAH)T-Temporomandibular joint dysfunction, Tension-type headache, TumorsO-Other: pressure, traction, or displacement of extracerebral structures.I-Indomethacin-responsive headacheC-Cluster headache
I-Infections: septic heart valve vegetationsN-Neoplasms; Nonbacterial thrombotic endocarditisF-Fracture of the long boneA-Atherosclerosis, Atrial fibrillation-related emboli R-Reperfusion -> infarct -> hemorrhageC-Carotid atheromas or mural thrombiT-Thrombotic occlusionsS-Sylvan fissure: MCA is a particularly common site.
D-Dysarthria and a contralateral clumsy hand or arm due to infarction in the base of the pons or in the genuof 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 lacunaeP-Pontine lesionsA-Ataxic hemiparesis due to an infarct in the base of the ponsR-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
*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-ApraxiaB-Blindness in corresponding half of the visual field (contralateral homonymous hemianopsia)C-Contralateral Clumsiness of arm, face. -- Leg is somewhat spared.
M-Memorization difficultiesC-Calculation difficultiesA-Aphasia with language-dominant hemispheral involvement
P-Proximal fling movementsO-Occipital lobe infarction results in contralateral homonymous hemianopsia which may be completeS-Speech and Spelling maintained, but unable to read fluentlyT-Thalamic syndrome
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 strokeH-Hypertension, HyperlipidemiaA-Amaurosis fugax (transient monocular blindness)D-DDx: seizures, neoplasms, migraine, vertigoE-Extrinsic factor is monitored for warfarin administration; E-EndarterectomyD-Diabetes