Anaesthesia machine/room check

MS MAID:

• Monitors (EKG, SpO2, EtCO2, etc.)
• Suction
• Machine check (according to ASA guidelines)
• Airway equipment (ETT, laryngoscope, oral/nasal airway)
• IV equipment
• Drugs (emergency, inductions, NMBs, etc.)

Endotracheal intubation: diagnosis of poor bilateral breath sounds after intubation

DOPE:

• Displaced (usually right mainstem, pyriform fossa, etc.)
• Obstruction (kinked or bitten tube, mucous plug, etc.)
• Pneumothorax (collapsed lung)
• Esophagus

General anaesthesia: equipment check prior to inducing

MALES:

• Masks
• Airways
• Laryngoscopes
• Endotracheal tubes
• Suction/Stylette, bougie

Spinal anaesthesia agents

"Little Boys Prefer Toys":

• Lidocaine
• Bupivacaine
• Procaine
• Tetracaine

Xylocaine: where not to use with epinephrine

"Ears, nose, hose, fingers, and toes"

• The vasoconstrictive effects of xylocaine with epinephrine are helpful in providing hemostasis while suturing; however, they may also cause local ischemic necrosis in distal structures such as the digits, tip of nose, penis, ears, etc.

"Digital PEN" – digits, penis, ear, nose

Depression: major episode characteristics

SPACE DIGS:

• Sleep disruption
• Psychomotor retardation
• Appetite change
• Concentration loss
• Energy loss
• Depressed mood
• Interest wanes
• Guilt
• Suicidal tendencies

Depression: DSM-V criteria for major depressive disorder

"SIG E CAPS":

• Sleep disturbances
• Interest decreased (anhedonia)
• Guilt and/or feelings of worthlessness
• Energy decreased
• Concentration problems
• Appetite/weight changes
• Psychomotor agitation or retardation
• Suicidal ideation

Gain: primary vs. secondary vs. tertiary

• Primary: patient's psyche improved
• Secondary: symptom sympathy for patient
• Tertiary: therapist's gain

Kubler-Ross dying process: stages

"Death always brings great acceptance":

• Denial
• Anger
• Bargaining
• Grieving
• Acceptance

Middle adolescence (14–17 years): characteristics

HERO:

• Heterosexual/Homosexual crushes
• Education regarding short-term benefits
• Risk-taking
• Omnipotence

Narcolepsy: symptoms, epidemiology

CHAP:

• Cataplexy
• Hallucinations
• Attacks of sleep
• Paralysis on waking
• Usual presentation is a young male, hence "chap"

Suicide: risk screening

SAD PERSONS scale:

• Sex (male – completion, female – attempt)
• Age (adolescent or elderly)
• Depression
• Previous attempt
• Ethanol abuse
• Rational thinking loss
• Social support problems
• Organised plan
• No spouse
• Sickness (chronic illness)

Sleep stages: features

Delta waves during Deepest sleep (stages 3 and 4, slow-wave)

dREaM during REM sleep

Impotence causes

PLANE:

• Psychogenic: performance anxiety
• Libido: decreased with androgen deficiency, drugs
• Autonomic neuropathy: impede blood flow redirection
• Nitric oxide deficiency: impaired synthesis, decreased blood pressure
• Erectile reserve: cannot maintain an erection

Male erectile dysfunction (MED): biological causes

MED:

• Medicines (propranolol, methyldopa, SSRIs, etc.)
• Ethanol
• Diabetes mellitus

Premature ejaculation: treatment

2 S's:

• SSRIs
• Squeezing technique (glans pressure before climax)

More detail with 2 more S's:

• Sensate-focus exercises (relieves anxiety)
• Stop and start method (5–6 rehearsals of stopping stimulation before climax)

B vitamin names

"The rhythm nearly proved contagious":

In increasing order:

• Thiamine (vitamin B1, also spelled thiamin)
• Riboflavin (vitamin B2)
• Niacin (vitamin B3, also called nicotinic acid)
• Pyridoxine (vitamin B6)
• Cobalamin (vitamin B12)

Essential amino acids

"TIM HALL PVT. (Ltd.) always argue and never (get) tire":

• Phe – phenylalanine
• Val – valine
• Thr – threonine
• Trp – tryptophan
• Ile – isoleucine
• Met – methionine
• His – histidine
• Arg – arginine
• Leu – leucine
• Lys – lysine
• Always argue: A is for Arg (Arginine) not Asp (Aspartic acid).
• 'Never tire': T is not Tyr (Tyrosine), but is both Thr (Theronine) and Trp (Tryptophan).

†Note that this initialism uses single letters for each amino acid that are not the same as the standard single-letter codes commonly used in molecular biology to uniquely specify each amino acid; for example, though phenylalanine is represented here by the letter "P", it is formally represented by the letter "F" in most other contexts, and "P" is instead used to formally represent proline.

Fasting state: branched-chain amino acids used by skeletal muscles

"Muscles LIVe fast":

• Leucine
• Isoleucine
• Valine

Fat-soluble vitamins

"The fat (fat-soluble vitamins) cat lives in the ADEK (vitamins A, D, E, and K)."^[3]

Folate deficiency: causes

A FOLIC DROP:

• Alcoholism
• Folic acid antagonists
• Oral contraceptives
• Low dietary intake
• Infection with Giardia
• Celiac sprue
• Dilantin
• Relative folate deficiency
• Old
• Pregnant

Glycogen storage: Anderson's (IV) vs. Cori's (III) enzyme defect

ABCD:

• Anderson's = Branching enzyme
• Cori's = Debranching enzyme
• Otherwise, cannot really distinguish clinically.

Glycogen storage: names of types I through VI

"Viagra pills cause a major hardon tendency":

• Von Gierke's
• Pompe's
• Cori's
• Anderson's
• McArdle's
• Her's
• Tarui's

Enzyme classes

"'On The Hill, LIL' Transformers":

• 1 - Oxidoreductases
• 2 - Transferases
• 3 - Hydrolases
• 4 - Lyases
• 5 - Isomerases
• 6 - Ligases
• 7 - Translocases

Acute LVF management

LMNOP:^[4]

• Lasix (furosemide)
• Morphine (diamorphine)
• Nitrates
• Oxygen (sit patient up)
• Pulmonary ventilation (if doing badly)

Atrial fibrillation: causes of new onset

THE ATRIAL FIBS:^[4]

• Thyroid
• Hypothermia
• Embolism (P.E.)
• Alcohol
• Trauma (cardiac contusion)
• Recent surgery (post CABG)
• Ischemia
• Atrial enlargement
• Lone or idiopathic
• Fever, anemia, high-output states
• Infarct
• Bad valves (mitral stenosis)
• Stimulants (cocaine, theo, amphet, caffeine)

Well's criteria

Secret little TIP (about) blood clots:^[4]

Signs/symptoms of PE (3)

PE is the most likely diagnosis (3)

Tachycardia >100bpm (1.5)

Iimmobilisation/surgery in the last 4 weeks (1.5)

Previous DVT/PE

Blood in sputum (haemoptysis) (1)

Active cancer (1)

Two tier score: PE likely > 4

Causes of life-threatening chest pain

PET-MAC^[5]

• P = Pulmonary embolism
• E = Esophageal rupture
• T = Tension pneumothorax
• M = Myocardial infarction
• A = Aortic dissection
• C = Cardiac tamponade

GCS intubation

Under 8, intubate.^[6]

Ipecac: contraindications

4 C's:^[4]

• Comatose
• Convulsing
• Corrosive
• hydrocarbon

JVP: raised JVP differential

PQRST(EKG waves):^[4]

• Pericardial effusion
• Quantity of fluid raised (fluid over load)
• Right heart failure
• Superior vena caval obstruction
• Tricuspid stenosis/tricuspid regurgitation/tamponade (cardiac)

MI: immediate treatment

DOGASH:^[4]

• Diamorphine
• Oxygen
• GTN spray
• Aspirin 300 mg
• Streptokinase
• Heparin

PEA/asystole (ACLS): cause

ITCHPAD^[4]

Infarction

Tension pneumothorax

Cardiac tamponade

Hypovolemia/hypothermia/hypo-,hyperkalemia/hypomagnesmia/hypoxemia

Pulmonary embolism

Acidosis

Drug overdose

Rapid sequence intubation (RSI)

SOAP ME

Suction

Oxygen

Airway equipment

Positioning

Monitoring & medications

EtCO2 & other equipment^[7]

Rapid sequence intubation medications (RSI) (CCRx)

Very calmly engage the respiratory system

Vecuronium 0.1 mg/kg^[8]

Cisatracurium 0.2 mg/kg^[8]

Etomidate 0.3 mg/kg^[8]

Rocuronium 0.6 mg/kg-1.2 mg/kg^[8]

Succinylcholine 1 mg/kg^[8]

Shock: signs and symptoms

TV SPARC CUBE:^[4]

Thirst

Vomitting

Sweating

Pulse weak

Anxious

Respirations shallow/rapid

Cool

Cyanotic

Unconscious

BP low

Eyes blank

Shock: types

RN CHAMPS (Alternatively: "MR. C.H. SNAP", or "NH CRAMPS"):

Respiratory

Neurogenic

Cardiogenic

Hemorrhagic

Anaphylactic

Metabolic

Psychogenic

Septic^[9]

Subarachnoid hemorrhage (SAH) causes

BATS:^[4]

Berry aneurysm

Arteriovenous malformation/adult polycystic kidney disease

Trauma

Stroke

Syncope causes, by system

HEAD HEART VESSELS:^[4]

CNS causes include HEAD:

Hypoxia/hypoglycemia

Epilepsy

Anxiety

Dysfunctional brain stem (basivertebral TIA)

Cardiac causes are HEART:

Heart attack

Embolism (PE)

Aortic obstruction (IHSS, AS or myxoma)

Rhythm disturbance, ventricular

Tachycardia

Vascular causes are VESSELS:

Vasovagal

Ectopic (reminds one of hypovolemia)

Situational

Subclavian steal

ENT (glossopharyngeal neuralgia)

Low systemic vascular resistance (Addison's, diabetic vascular neuropathy)

Sensitive carotid sinus

Tension pneumothorax: signs and symptoms

P-THORAX^[10]

Pleuritic pain

Tracheal deviation

Hyperresonance

Onset sudden

Reduced breath sounds (and dyspnea)

Absent fremitus

X-ray shows collapse

TWEED SASH

Non-pharmacological analgesia.^[11]

Ventricular fibrillation: treatment

Shock, shock, shock, everybody shock, little shock, big shock, momma shock, poppa shock:^[4]

Shock= Defibrillate

Everybody= Epinephrine

Little= Lidocaine

Big= Bretylium

Momma= MgSO₄

Poppa= Procainamide

Diabetes complications

KNIVES:^[12]

Kidney – nephropathy

Neuromuscular – peripheral neuropathy, mononeuritis, amyotrophy

Infective – UTIs, TB

Vascular – coronary/cerebrovascular/peripheral artery disease

Eye – cataracts, retinopathy

Skin – lipohypertrophy/lipoatrophy, necrobiosis lipoidica

Anterior mediastinal masses

4 T's:

Teratoma

Thymoma

Testicular-type

T-cell / Hodgkin's lymphoma

Dermatomyositis or polymyositis: risk of underlying malignancy

Risk is 30% at age 30. Risk is 40% at age 40, and so on.

Lung cancer: main sites for distant metastases

BLAB:

Bone

Liver

Adrenals

Brain

Esophageal cancer: risk factors

ABCDEF:

Achalasia

Barret's esophagus

Corrosive esophagitis

Diverticuliis

Esophageal web

Familial

Lung cancer: notorious consequences

SPEECH:

Superior vena cava syndrome

Paralysis of diaphragm (phrenic nerve)

Ectopic hormones

Eaton-Lambert syndrome

Clubbing

Horner syndrome/ hoarseness

Mole: signs of trouble

ABCDE:

Asymmetry

Border irregular

Colour irregular

Diameter usually > 0.5 cm

Elevation irregular

Prognotic factors for cancer: general

PROGNOSIS:

Presentation (time & course)

Response to treatment

Old (bad prog.)

Good intervention (i.e. early)

Non-compliance with treatment

Order of differentiation (>1 cell type)

Stage of disease

Ill health

Spread (diffuse)

Pituitary endocrine functions often affected by pituitary-associated tumor

"Go look for the adenoma please":

Tropic hormones affected by growth tumor are:

GnRH

LSH

FSH

ACTH

Prolactin function

Abdominal 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

Evisceration/ ecchymosis

Rebound tenderness: infection

Masses

Altered level of consciousness: reasons

AEIOU TIPS

Alcohol

Epilepsy, electrolytes, and encephalopathy

Insulin

Overdose, oxygen

Underdose, uremia

Trauma, temperature

Infection

Psychogenic, poisons

Stroke, shock^[13]

Deep tendon reflexes (DTR's)

One two, put on my shoe - S1/2 roots for Achilles reflex (foot plantarflexion)

Three four, kick the door - L3/4 roots for patellar reflex (knee extension)

Five six, pick up sticks - C5/6 roots for brachioradialis and biceps brachii reflexes (elbow flexion)

Seven eight, shut the gate - C7/8 roots for triceps brachii reflex (elbow extension)

Cause of symptoms

OPQRST (Works well for cardiac, and respiratory patients.)^[14]

Onset of the event

Provocation or palliation

Quality of the pain

Region and radiation

Severity

Time

Fetal monitoring

VEAL CHOP

^[15]

Neurovascular assessment

5 P's:

Pain

Pallor

Paresthesia

Pulse

Paralysis^[16]

Trauma assessment

DCAP-BTLS

Deformities & discolorations

Contusions

Abrasions & avulsion

Penetrations & punctures

Burns

Tenderness

Lacerations

Swelling & symmetry

BP-DOC

Bleeding

Pain

Deformities

Open wounds

Crepitus

Toxicological seizures: causes

OTIS CAMPBELL

Organophosphates

Tricyclic antidepressants

Isoniazid, insulin

Sympathomimetics

Camphor, cocaine

Amphetamines

Methylxanthines

PCP, propoxyphene, phenol, propranolol

Benzodiazepine withdrawal, botanicals

Ethanol withdrawal

Lithium, lidocaine

Lindane, lead^[17]

Vomiting: non-GIT differential

ABCDEFGHI:

Acute renal failure

Brain [increased ICP]

Cardiac [inferior MI]

DKA

Ears [labyrinthitis]

Foreign substances [paracetamol, theo, etc.]

Glaucoma

Hyperemesis gravidarum

Infection [pyelonephritis, meningitis]

Heart valve auscultation sites

"All patients take meds":

Reading from top left:

Aortic

Pulmonary

Tricuspid

Mitral

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 withdrawal)

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]

History

SAMPLE history

Signs and symptoms

Allergies

Medications

Past medical history, injuries, illnesses

Last meal/intake

Events leading up to the injury and/or illness

OPQRST history

Onset of symptoms

Provocation/pallitive

Quality or character of pain

Region of pain or radiation

Signs, symptoms and severity

Time of onset, duration, intensity

Orthopaedic assessment

CLORIDE FPP

Character: sharp or dull pain

Location: region (joint) of origin

Onset: sudden vs. gradual

Radiation:

Intensity: how severe (scale 1–10), impact on ADLs (activities of daily living), is it getting better, worse or staying the same?

Duration: acute vs. chronic

Events associated: falls, morning stiffness, swelling, redness, joint clicking or locking, muscle cramps, muscle wasting, movement limitation, weakness, numbness or tingling, fever, chills, trauma (mechanism of injury), occupation activities, sports, repetitive movements

Frequency: intermittent vs. constant, have you ever had this pain before?

Palliative factors: is there anything that makes it better? (rest, activity, meds, heat, cold)

Provocative factors: is there anything that makes it worse? (rest, activity, etc.)^[18]

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'

PLOTRADIO

Past history

Location

Onset/offset

Type/character (of pain)

Radiation

Aggravating/alleviating factors

Duration

Intensity

Other associated symptoms

Abdominal swelling causes

9 F's:

Fat

Feces

Fluid

Flatus

Fetus

Full-sized tumors

Full bladder

Fibroids

False pregnancy

Head trauma: rapid neuro exam

12 P's

Psychological (mental) status

Pupils: size, symmetry, reaction

Paired ocular movements

Papilloedema

Pressure (BP, increased ICP)

Pulse and rate

Paralysis, paresis

Pyramidal signs

Pin prick sensory response

Pee (incontinent)

Patellar reflex

Ptosis

Ocular bobbing vs. dipping

"Breakfast is fast, dinner is slow, both go down":

Bobbing is fast

Dipping is slow

In both, the initial movement is down.

Pupillary dilation (persistent): causes

3AM:

3rd nerve palsy

Anti-muscarinic eye drops (e.g. to facilitate fundoscopy)

Myotonic pupil

Clinical examination: initial Inspection of patient from end of bed

ABC:

Appearance (SOB, pain, etc.)

Behaviour

Connections (drips, inhalers, etc. connected to patient)

Differential diagnosis checklist

"A VITAMIN C"

Acquired

Vascular

Inflammatory (infectious and non-infectious)

Trauma/ toxins

Autoimmune

Metabolic

Idiopathic

Neoplastic

Congenital

Primitive reflexes

"Absent reflexes should get paediatrics professors mad"

Absent: asymmetrical tonic neck reflex

Reflexes: rooting reflex

Should: suck reflex

Get: grasp reflex

Paediatrics: placing reflex

Professors: parachute reflex

Mad: Moro reflex

Family history (FH)

BALD CHASM:

Blood pressure (high)

Arthritis

Lung disease

Diabetes

Cancer

Heart disease

Alcoholism

Stroke

Mental health disorders (depression, etc.)

Four point physical assessment of a disease

"I'm a people person"

Inspection

Auscultation

Percussion

Palpation

Medical history: disease checklist

MJ THREADS:

Myocardial infarction

Jaundice

Tuberculosis

Hypertension

Rheumatic fever/ rheumatoid arthritis

Epilepsy

Asthma

Diabetes

Strokes

Past medical history (PMH)

VAMP THIS:

Vices (tobacco, alcohol, other drugs, sexual risks)

Allergies

Medications

Preexisting medical conditions

Trauma

History of hospitalizations

Immunizations

Surgeries

SMASH FM:

Social history

Medical history

Allergies

Surgical history

Hospitalizations

Family history

Medications

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

Patient profile (PP)

LADDERS:

Living situation/ lifestyle

Anxiety

Depression

Daily activities (describe a typical day)

Environmental risks / exposure

Relationships

Support system / stress

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

Short stature 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)

Sign vs. symptom

S&S:

Sign: I (the examiner) can detect attributes/reactions without patient description

Symptom: patient only can sense attributes/feelings

Social history

FED TACOS:

Food

Exercise

Drugs

Tobacco

Alcohol

Caffeine

Occupation

Sexual activity

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

Surgical sieve for diagnostic categories (alternate)

PAST MIDNIGHT:

Psychological

Autoimmune

Spontaneous/idiopathic

Toxic

Metabolic

Inflammatory

Degenerative

Neoplastic

Infection

Genetic

Hematological

Traumatic

VITAMIN CDEF:

Vascular

Infective/inflammatory

Traumatic

Autoimmune

Metabolic

Iatrogenic/idiopathic

Neoplastic

Congenital

Degenerative/developmental

Endocrine/environmental

Functional

Breast history checklist

LMNOP:

Lump

Mammary changes

Nipple changes

Other symptoms

Patient risk factors

Delivering bad news

SPIKES:

Setting up

Perception

Invitation

Knowledge

Emotions

Strategy and summary

Dialysis: Acute indications

AEIOU^[19]

Acidosis (refractory to treatment)

Electrolyte abnormalities (refractory to treatment, e.g. hyperkalemia)

Ingestions (e.g. methanol, ethylene glycol, lithium, salicylates)

Overload (volume overload refractory to IV diuresis)

Uremia (presenting with pericarditis, bleeding, encephalopathy)

Chorea: common causes

St. VITUS'S DANCE:^[4]

Sydenhams

Vascular

Increased RBC's (polycythemia)

Toxins: CO, Mg, Hg

Uremia

SLE

Senile chorea

Drugs

APLA syndrome

Neurodegenerative conditions: HD, neuroacanthocytosis, DRPLA

Conception related: pregnancy, OCP's

Endocrine: hyperthyroidism, hypo-, hyperglycemia

Congenital myopathy: features

DREAMS:^[4]

Dominantly inherited, mostly

Reflexes decreased

Enzymes normal

Apathetic floppy baby

Milestones delayed

Skeletal abnormalities

Dementia: reversible dementia causes

DEMENTIA:^[4]

Drugs/depression

Elderly

Multi-infarct/medication

Environmental

Nutritional

Toxins

Ischemia

Alcohol

Friedreich ataxia trinucleotide repeat

"Ataxic GAAit"

Guanine

Adenine

Adenine ^[20]

Stroke risk factors

HEADS:^[4]

Hypertension/ hyperlipidemia

Elderly

Atrial fib

Diabetes mellitus/ drugs (cocaine)

Smoking/sex (male)

Horner syndrome

Horny PAMELA:

Ptosis

Anhydrosis

Miosis

Enophthalmos

Loss of ciliary-spinal reflex

Anisocoria

Cerebellar signs

DANISH:

• Dysdiadochokinesia / dysmetria
• Ataxia
• Nystagmus (horizontal)
• Intention tremor
• Slurred speech
• Hypotonia

Causes of pinpoint pupils

Pinpoint pupils are caused by opioids and pontine pathology

Diagnostic criteria of neurofibromatosis type 1

CAFÉ SPOT:

• Café au lait spots
• Axillary + inguinal freckling
• Fibromas
• Eye: Lisch nodules
• Sphenoid dysplasia
• Positive family history
• Optic tumour (glioma)

Features of normal pressure hydrocephalus

Wet, wobbly, wacky:

• Wet = urinary incontinence
• Wobbly = ataxic gait
• Wacky = dementia

Gynaecomastia causing drugs

Some drugs create awesome knockers

Spironolactone

Digitalis

Cimetidine

Alcohol

Ketoconazole^[21]

Conduct disorder vs. antisocial personality disorder

Conduct disorder is seen in children. Antisocial personality disorder is seen in adults.

Depression: symptoms and signs (DSM-IV criteria)

AWESOME:

Affect flat

Weight change (loss or gain)

Energy, loss of

Sad feelings/ suicide thoughts or plans or attempts/ sexual inhibition/ sleep change (loss or excess) / social withdrawal

Others (guilt, loss of pleasure, hopeless)

Memory loss

Emotional blunting

Depression

UNHAPPINESS:

Understandable (such as bereavement, major stresses)

Neurotic (high anxiety personalities, negative parental upbringing, hypochondriasis)

Agitation (usually organic causes such as dementia)

Pseudodementia

Pain

Importuniing (whingeing, complaining)

Nihilistic

Endogenous

Secondary (i.e. cancer at the head of the pancreas, bronchogenic cancer)

Syndromal

Delirium

DIMES & 3Ps:

Drugs (or withdrawal)

Infection (PUS = Pneumonia, UTI, Skin)

Metabolic (e.g. Na, Ca, TSH)

Environmental

Structural

Pain

Pee

Poo

I WATCH DEATH^[22]
Infections – PUS, CNS

Withdrawal – alcohol, sedatives, barbiturates

Acute metabolic changes – pH, hypo/hyper Na, Ca, acute liver or renal failure

Trauma – brain injury, subdural hematoma

CNS – post-ictal, stroke, tumour, brain mets

Hypoxia – CHF, anemia

Deficiencies – thiamine, niacin, B12 (e.g. chronic G and T alcoholics)

Endocrinopathies – hypo-/hyper-cortisol, hypoglycemia

Acute vascular – hypertensive encephalopathy, septic hypotension

Toxins and Drugs – especially anti-cholinergics, opioids, benzodiazepines

Heavy metals

PINCH ME

Pain

Infection

Nutrition

Constipation

Hydration

Medication

Electrolytes

Erikson's developmental stages

"The sad tale of Erikson Motors":

• The stages in order by age group:

Mr. Trust and MsTrust had an auto they were ashamed of. She took the initiative to find the guilty party. She found the industry was inferior. They were making cars with dents [identity] and rolling fuses [role confusion]. Mr. N.T. Macy [intimacy] isolated the problem, General TVT absorbed the cost. In the end, they found the tires were just gritty and the should have used de- spare!

Mental state examination

ASEPTIC:

Appearance

Speech

Emotion (objective/subjective)

Perceptions

Thoughts

Insight

Cognition

Mania: cardinal symptoms

DIG FAST:

Distractibility

Indiscretion (DSM-IV's "excessive involvement in pleasurable activities")

Grandiosity

Flight of ideas

Activity increase

Sleep deficit (decreased need for sleep)

Talkativeness (pressured speech)

Mania: diagnostic criteria

Must have 3 of MANIAC:

Mouth (pressure of speech)/ Moodl

Activity increased

Naughty (disinhibition)

Insomnia

Attention (distractibility)

Confidence (grandiose ideas)

Parasomnias: time of onset

Sleep terrors and Sleepwalking occur during Slow-wave sleep (stages 3 & 4).Nightmare occurs during REM sleep (and is remembered).

Psychiatric review of symptoms

"Depressed patients seem anxious, so call psychiatrists":

Depression and other mood disorders (major depression, bipolar disorder, dysthymia)

Personality disorders (primarily borderline personality disorder)

Substance abuse disorders

Anxiety disorders (panic disorder with agoraphobia, obsessive-compulsive disorder)

Somatization disorder, eating disorders (these two disorders are combined because both involve disorders of bodily perception)

Cognitive disorders (dementia, delirium)

Psychotic disorders (schizophrenia, delusional disorder and psychosis accompanying depression, substance abuse or dementia)

Schizophrenia: negative features

4 A's:

Ambivalence

Affective incongruence

Associative loosening

Autism

Substance dependence: features (DSM IV)

WITHDraw IT:

• 3 of 7 within 12-month period:

Withdrawal

Interest or Important activities given up or reduced

Tolerance

Harm to physical and psychosocial known but continue to use

Desire to cut down, control

Intended time, amount exceeded

Time spent too much

Chest radiograph: checklist to examine

"Pamela found our rotation particularly exciting; very highly commended mainly 'cus she arouses":

Patient details

Film details

Objects (e.g. lines, electrodes)

Rotation

Penetration

Expansion

Vessels

Hila

Costophrenic angles

Mediastinum

Cardiothoracic ratio

Soft tissues and bones

Air (diaphragm, pneumothorax, subcut. emphysema)

Chest X-ray interpretation

Preliminary is ABCDEF:

AP or PA

Body position

Confirm name

Date

Exposure

Films for comparison

Analysis is ABCDEF:

Airways (hilar adenopathy or enlargement)

Breast shadows / bones (rib fractures, lytic bone lesions)

Cardiac silhoutte (cardiac enlargement) / costophrenic angles (pleural effusions)

Diaphragm (evidence of free air) / digestive tract

Edges (apices for fibrosis, pneumothorax, pleural thickening or plaques) / extrathoracic tissues

Fields (evidence of alveolar filling) / failure (alveolar air space disease with prominent vascularity with or without pleural effusions)

Chest X-ray: cavitating lesions differential

"If you see holes on chest X-ray, they are weird":

Wegener's granulomatosis (now known as granulomatosis with polyangiitis)

Embolic (pulmonary, septic)

Infection (anaerobes, pneumocystis, TB)

Rheumatoid (necrobiotic nodules)

Developmental cysts (sequestration)

Histiocytosis

Oncological

Lymphangioleiomyomatosis

Environmental, occupational

Sarcoid

Alternatively: L=Left atrial myxoma

Elbow ossification centers, in sequence

CRITOE:

Capitellum

Radial head

Internal epicondyle

Trochlea

Olecranon

External epicondyle

Head CT scan: evaluation checklist

"Blood can be very bad":

Blood

Cistern

Brain

Ventricles

Bone

Neck sagittal x-ray: examination checklist

ABCD:

Anterior: look for swelling

Bones: examine each bone for fractures

Cartilage: look for slipped discs

Dark spots: ensure not abnormally big, or could mean excess blood

Osteoarthritis: x-ray signs

LOSS:

Loss of joint space

Osteopyhtes

Subcondral sclerosis

Subchondral cysts

T2 vs. T1 MRI scan

"WW 2" (World War II):

Water is white in a T2 scan.

Conversely, a T1 scan shows fat as being whiter.

Upper lobe shadowing: causes

BREASTS:

Beryllium

Radiation

Extrinsic allergic alveolitis

Ankylosing spondylitis

Sarcoidosis

TB

Siliconiosis

Airway assessment

LEMON

• Look
• Evaluate
• Mallampati
• Occlusion
• Neck mobility

PIPPA

• Position
• Inspection
• Palpation
• Percussion
• Auscultation

Asthma management

ASTHMA

• Adrenergic agonists
• Steroids
• Theophylline
• Hydration
• Masked oxygen
• Anticholinergics^[23]

COPD assessment test (CAT)^[24]

CAT items: CHEST SEA

To aid memory, think of the chest (or lungs) floating in a sea of yellow sputum, which is commonly seen in COPD.

• Cough
• Home-leaving confidence
• Exercise tolerance (uphill/ 1 flight of stairs)
• Sputum (phlegm/ mucus)
• Tightness of chest
• Sleep
• Energy level
• ADL at home

Croup symptoms

• 3 S's:
  • Stridor
  • Subglottic swelling
  • Seal-bark cough

Causes of upper zone pulmonary fibrosis

A TEA SHOP

• ABPA
• TB
• Extrinsic allergic alveolitis
• Ankylosing spondylitis
• Sarcoidosis
• Histiocytosis
• Occupational (silicosis, berylliosis)
• Pneumoconiosis (coal-worker's)

Features of a life-threatening asthma attack

A CHEST

• Arrhythmia/altered conscious level
• Cyanosis, PaCO2 normal
• Hypotension, hypoxia (PaO2<8kPa, SpO2 <92%)
• Exhaustion
• Silent chest
• Threatening PEF < 33% best or predicted (in those >5yrs old)

Pulmonary edema: treatment

LMNOP:

Lasix

Morphine

Nitro

Oxygen

Position/positive pressure ventilation^[25]

Cholinergic crisis

SLUDGE and the Killer B's:

Salivation

Lacrimation

Urination

Diaphoresis, diarrhea

Gastrointestinal cramping

Emesis

Bradycardia

Bronchospasm

Bronchorrhea^[26]

also known as DUMBBELLS

Diarrhea

Urination

Miosis

Bradycardia

Bronchospasm

Emesis

Lacrimation

Loss of muscle strength

Salivation/sweating

Cheyne-Stokes breathing

Cheyne-Stokes breathing sounds like "chain smokes"

Drugs causing gynaecomastia: DISCO

• Digitalis
• Isoniazid
• Spironolactone
• Cimetidine / ketoconazole
• Oestrogen

Drugs for bradycardia and hypotension

Isoproterenol

Dopamine

Epinephrine

Atropine sulfate

Diaphragm innervation

C3, 4, 5 keeps the diaphragm alive^[27]

Intubation preparation

7 P's

Preparation

Preoxygenation

Pretreatment

Paralysis with induction

Positioning

Placement of tube

Postintubation management^[28]

Pentad of TTP

FAT RN:

Fever

Anemia

Thrombocytopenia

Renal

Neuro changes^[29]

Systemic lupus erythematosus: diagnostic symptoms

SOAP BRAIN MD

Serositis

Oral ulcers

Arthritis

Photosensitivity, pulmonary fibrosis

Blood cells

Renal, Raynaud's

ANA

Immunologic (anti-Sm, anti-dsDNA)

Neuropsych

Malar rash

Discoid rash however, not in order of diagnostic importance.