Mnemocine

ABCs for abnormal LFTs mnemonic

dokidok — Sun, 05 Feb 2012 05:35:57 +0000

Causes of Elevated ALT or AST Values in Asymptomatic Patients*
A
Autoimmune hepatitis
B
Hepatitis B
C
Hepatitis C
D
Drugs or toxins
E
Ethanol
F
Fatty liver
G
Growths (i.e., tumors)
H
Hemodynamic disorder (congestive heart failure)
I
Iron (hemochromatosis), copper (Wilson’s disease) or alpha1-antitrypsin deficiency
M
Muscle injury

DIAPERS mnemonic for new onset incontinence

dokidok — Wed, 25 Jan 2012 03:30:47 +0000

A 66-year-old woman, who resides in a nursing home following a stroke, is hospitalized because of loose stools and confusion. On the second hospital day, the patient has two episodes of urinary incontinence. Neither the nursing-home staff nor family members report previous problems with incontinence. Medical history is significant for a cerebrovascular accident with severe aphasia and left hemiparesis, hypertension, and type 2 diabetes mellitus. Current medications are aspirin, dipyridamole, lisinopril, and glipizide.

On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 164/96 mm Hg, pulse rate is 92/min, and respiration rate is 18/min. Arterial oxygen saturation is 98% on ambient air. Results of cardiopulmonary, abdominal, and rectal examinations are normal. On neurologic examination, the patient is not oriented to place or date and she keeps trying to climb out of bed. There is expressive aphasia and moderate weakness of the left arm and leg.

Laboratory studies:
Complete blood count	Normal
Calcium	8.6 mg/dL (2.15 mmol/L)
Creatinine	1.2 mg/dL (106.1 µmol/L)
Glucose	100 mg/dL (5.55 mmol/L)
Electrolytes	Normal
Urinalysis	2+ glucose, moderate protein, 10-20 leukocytes and 3-5 erythrocytes/hpf

Results of urine and blood cultures are pending. An electrocardiogram and chest radiograph are normal.

Which of the following is the best management for this patient’s incontinence?

A) Begin ciprofloxacin

B) Discontinue glipizide

C) Insert an indwelling urinary catheter

D) Schedule a CT scan of the head

Answer and Critique (Correct Answer: A)

Educational Objective:Manage reversible causes of urinary incontinence.

Key Point

Empiric antibiotic treatment pending the results of a urine culture may be warranted in elderly patients with new-onset urinary incontinence and pyuria.

This patient with new-onset urinary incontinence should first be evaluated for transient, reversible causes, for which the mnemonic DIAPERS may be useful: Drugs, Infection, Atrophic vaginitis, Psychological (depression, delirium, dementia), Endocrine (hyperglycemia, hypercalcemia), Restricted mobility, and Stool impaction. Urinary tract infection is a very common cause of transient incontinence in the elderly, particularly if other contributing factors such as cognitive impairment or impaired mobility are present. The presence of significant pyuria in this setting generally justifies administration of empiric antibiotic therapy pending urine culture results. Therefore, beginning ciprofloxacin is appropriate for this patient.

Although some medications may induce transient incontinence, causative agents are most often diuretics or drugs that affect autonomic nervous system or bladder function. Oral hypoglycemic agents do not typically cause incontinence, and discontinuing these agents in a patient with diabetes mellitus could precipitate hyperglycemia and increased incontinence.

Indwelling catheterization is a treatment of last resort for patients who have chronic incontinence that is unresponsive to other therapy and in whom intermittent catheterization is not feasible.

This patient’s confusion is more consistent with delirium in an elderly patient as a generalized response to an acute illness rather than a focal neurologic event. CT scan of the head is typically not helpful in such patients and is unlikely to provide an explanation for this patient’s incontinence.

The question and answer are from MKSAP 15.

Calcium Channel Blockers use in ACS

dokidok — Fri, 31 Dec 2010 19:09:04 +0000

This mnemonic graduated from the wiki-mnemo-lab. Feel free to contribute and help develop some of the other mnemonics on the same website.

When are CCBs (verapamil, diltiazem) the answer for Acute Coronary Syndrome (ACS)?

Cannot take beta-Blockers: the Pt has intolerance to beta-Blockers, such as severe reactive airway disease (asthma).

Cocaine-induced chest pain.

Coronary vasospasm / Prinzmetal’s angina.

Triple Screen Test

dokidok — Fri, 31 Dec 2010 16:31:14 +0000

It is not exactly a mnemonic, but a good way to remember some details about triple screen test.

To increase the sensitivity for detecting chromosomal abnormalities labs use the Triple Screen Test.

TRI-ple screen test is used for TRI-somy 18 and TRI-somy 21 (both 18 and 21 are TRI-somies and can be divided by 3). TRI-ple screen is test for MSAFP, estriol and beta-hCG.

In TRI-somy 18 everything is low.

TRI-somy 21 can be present like 2+1, which means that the first 2 are low and the second one is high (there is a + sign in front 1, which shows that the levels are high). Now, the question is, how to remember which one of MSAFP, estriol and beta-hCG is high. In Down syndrome there is a high amount of beta-amyloid (cause for Alzheimer’s Dz before 40 years of age). The other beta thing that is increased in Down syndrome is beta-hCG. Now, there is no way to forget what I just said.

Just a little point: in spina bifida AFP is high. Think that AFP leaks out trough the openings in the spinal column (the term spina bifida comes from Latin and literally means “split” or “open” spine) and its level is high. In Down syndrome the AFP level is down. This is kind of easy to remember.

Treatment of AMS in ED

dokidok — Fri, 31 Dec 2010 16:04:48 +0000

The contributor of this medical mnemonic is Sean. Thank you!

For patients who present to the ED with altered mental status you should always BeGiN FLUIDS

B1 (thiamine deficiency)
Glucose (hypoglycemic)
Naloxone (opioid intox)
FLUIDS (dehydration)

Note: although AMS (Altered Mental Status) might be due to hyperosmolar hyperglycemia in type II DM, raising the blood glucose by 100 pts will not significantly worsen their condition, while failing to treat hypoglycemia can have profound consequences.

Achalasia ABC mnemonic

dokidok — Sat, 15 May 2010 17:31:51 +0000

Achalasia–>Absence of relaxation.

Both liquid and solids dysphagia–>Barium swallow will show–>Bird peak–>Rx with Botulinum toxin (for pts who cannot tolerate more invasive procedures), or Balloon dilation=Pneumatic dilation (cost effective procedure that provides symptomatic relief).

CCB is another way of Rx. Secondary Achalasia may arise from Chaga’s disease. Achalasia is associated w/ increased risk of esophageal Carcinoma. Complication: Reflux of food–>aspiration Sx.

BDxT (best Dx test) is manometry showing failure of the LES to relax, as well as the absence of peristaltic waves in the upper esophagus. However endoscopy is required to ensure that there is no malignancy.

I am not a huge fan of the ABCs mnemonics. There are so many of them, so you can easily get confused. However, for Achalasia ABC seems to work fine. Let me know what you think and how to improve this mnemonic. Thanks!

Mnemocine is not down

dokidok — Wed, 05 May 2010 14:57:45 +0000

Hello everyone. I apologize for the inconvenience. Mnemocine website is not down, it just goes through a slight makeover. Please, check back in a few days. Thank you. Until the new posts are up and running visit this website for mnemonics.