Mnemonics and Things Flashcards
SIGECAPS
Depression:
Depressed or anhedonia x 2 weeks 4 of: 1. Guilt 2. Energy (low) 3. Concentration (low) 4. Appetite (up or down) 5. Psychomotor Agitation or Retardation 6. Sleep up or down 7. Death or SI
Cause distress or impair function
Not due to substance or med dx
Trial med: min. 6-12 months.
Recurrence: 50% in first year.
Psychiatry General Treatment Saying
Education
Crisis
Therapy
Pharmacology
Bipolar mania criteria
DIGFAST Elation or irritable x 1 week 3-4 of: - Distractibility - Irresponsible (high risk behaviour) - Grandiosity - Flight of Ideas - Activity goal directed or agitated - Sleep less - Talkative
+ cause impairment
+ not due to medical dx
Separation Anxiety Criteria
Developmental inappropriate Excessive anxiety w/ separation x1 month Min 3 of: - distress if separated - refusal to go to school - fear to be alone - refusal to sleep without attachment - worry can lead to separation - physical (h/a, abdo pain, N/V)
TX: CBT +/- SSRI. Back to school now!
Separation Anxiety Associated
Think Panic!
- Panic Disorder
- Tics
Generalized Anxiety Dx DSM
What is BE SKIM?
Most day x 6 months (think of things that take a while need a while for dx).
excessive anxiety and worry hard to control associated with 1 of: "BE SKIM" BE SKIM" - Blank mind (hard to concentrate) - Easy fatigue - Sleep disturbance - Keyed up/ on edge - Irritable - Muscle Tension
Tx: CBT +/- SSRI
Students Fear the 3 C’s
Panic Attack= min. 4 of
- Sweat
- Tremble
- Unsteady/ Dizzy
- De-realization
- Excess HR
- Nausea
- Tingling/ Paresthesia
- SOB/smothering
- Fear of death
Choking, Chills/Flush, Chest Pain
Note: peak 10 min and resolve by 40
Which DSM-5 Need one month versus 6 versus 12 months?
1 m= You would do something if this last 1 mo!
- separation anxiety
- panic attack
- PTSD
6 months
- generalized anxiety
- ADHD
- ODD
- CD (6 month of minimal 1 symp and 12 month of 3 symp)
- Schizophrenia
12 months:
- Tourette
- CD (6 month of minimal 1 symp and 12 month of 3 symp)
Panic Dx Criteria
min. 1 month
Recurrent panic attack
Worry of more OR change behaviour related to attack (i.e. avoid unfamiliar situation)
Tx: CBT +/- SSRI +/- short term benzo
Panic Disorder… and triad of:
= panic!
- separation anxiety
- Tourette
- ADHD
OCD DSM5 Criteria
Obsession and/or compulsion
time consuming/distress
not due to substance or psych dx
Obsession= recurrent persistent thought/ urge/ image
Unwanted
Causing distress
Try to ignore or neutralize (i.e. compulsion)
Compulsion= repetitive behaviour, act
To respond to obsession
NOT logically tied
Time consuming
Tx: CBT +/- SSRI
Tourette Definition
2 motor + 1 vocal tic
min. 1 year
<18 y.o.
Tx: reassure +/- clonidine
PTSD Mnemonic
TTRAUMA
- traumatic event (exposed or actual)
- negative thought (amnesia, blame)
- re-experience (intrusive, flashback)
- avoidance (trauma or related stimuli)
- unable to f’n
- month= x 1 month
- arousal up= irritable, aggressive, self-destructive.
ADHD: 6 by 6 mean?
6 symptom x 6 month
< 12 y.o. + 2 settings
w/ functional impairment
RF: M, low birth weight, in utero smoke, FHx
ADHD Meds: DAV and RBC
dextroamphetamine class:
DAV = Dexedrine -> Adderall -> Vyvanse
methylphenidate class RBC = ritalin -> Biphentin -> Concerta
ODD DSM criteria
6 month 4 of: Anger- lose temper, annoy, resentful Defiant- argue, won't follow rules, blame Vindictive
Tx: Triple P parents, youth anger management, stimulant, risperidone
VTAP psych mnemonic
Conduct Disorder
min. 3 x 12 month and min. 1 x 6 month
- Violation of rules: runs away, stay out
- Theft and defeceitfulness
- Aggression- people + animal
- Property- destroy via fire setting, damage
Delirium/Psychosis
DIMS
= drugs (withdrawal, substance use, steroid AE, lead)
= infection (meningitis, encephalitis)
= Metabolic (BG, lytes, low B12, thyroid, adrenal HTN crisis)
= Structure/Sz/ Syncope (trauma, injury, bleed, brain tumour, seizure dx)
Bilateral palpable kidney with pulmonary hypoplasia and HTN
Polycystic kidney dx
Nephrotic syndrome Triad
Edema (proteinuria > 3.5 g/24h or Pr:Cr > 250)
Low albumin
High Cholesterol
MUDPILES
AG Met Acidosis = Metformin, Methanol = Uremia = DKA = Propylene glycol = IEM/Iron/ Ibuprofn/ Isoniazid/ Inhalant (cyanide, carbon monoxide) = Lactic acidosis = Ethylene glycol = Salicylates (aspirin)
Prune belly syndrome
Deficient abdo muscle
B/L undescended testes
GU (uretheral obstruction, VUR, hydro)
HSP triad
Petechiae/purpua \+ 1 of: - arthritis - GI (pain, V/D, intussusception) - renal (IgA nephropathy) - histology
Bartter Syn Mnemonic
Metabolic “Alka-LOW-sis”
high pH + Low K
RTA : How to remember distal versus proximal
Type 1= 1 letter= H issue
= I in distal before proximal= Distal tubule
Proximal is opposite= type 2 = bicarb issue.
Dialysis Indications
AEIOU
- acidosis (severe intractable)
- electrolytes (high persistent K)
- Ingestion (ASA, Warfarin, Lithium, Carbamazepine)
- Overload or not enough
- Uremia (encephalopathy, pericarditis, bleeding, neuropathy)
HTN with low K persistently=
hyperaldosteronism
Admission criteria for ED
T < 36.1 HR < 50; < 45 asleep BP < 80/50; orthostatic long QT SI low K, phosphate, BG, Cl liver or renal complication failed outpatient
Anorexia Nervosa DSM5
Restricted intake (leading to wt loss)
Fear of gaining weight
Disturbance in weight/shape
Bulimia Nervosa DSM5
1/week x 3 months (B= put a 1 and then 3)
Binge eating (eat excessive amount + lack of control)
Compensatory behaviour (laxative, vomit, fast)
(+) Self-evaluation influenced by shape or weight
Avoidant Restrictive Food Intake DSM5 Disorder
Eating disturbance
Cause weight in loss OR nutritional deficiency OR dependence on enteral feed OR interfere w/ function
Not due to body image or fear of wt
Not due to other cultural or medical dx
Gender Dysphoria DSM5
Incongruence between experienced gender+ assigned x 6 months.
Tx: no puberty= Lupron no menses= continued OCP masculline= T feminize= estrogen, spironolactone Top-Sx; bottom as adult
Primary screening for substance abuse mnemonic
CRAFT
- Car (driven or ridden along w/)
- Relax (used to relax)
- Alone (used alone)
- Fam and friends tell you to cut down
- Forgotten things while using
- Trouble (gotten into it while using)
List contraindication to OCP
Migraine w/ aura uncontrolled severe HTN severe cirrhosis DM w/ late findings DVT, PE, hx of stroke SLE w/ (+) antiphospholipid antibody
Pelvic Inflammatory Disease Clinical Dx
lower abdo pain + 1
> adnexal tender
> uterine tender
> cervical motion tenderness
More likely if:
- fever
- mucopurulent d/c or WBC on saline prep
- high ESR or CRP
Tx: Cefotriaxone x 1 + Doxy x 14d
PID compilation: chronic pelvic pain, abscess, peritonitis, infertility, fitz-hugh-syndrome
Paediatric migraine Criteria
Min. 5 attack
Last 1-72 hour
H/a with: uni/bi lateral, throbbing, mod-severe pain, worse w/ activity
1 of: n/v or photo, phonophobia
What is the med overuse h/a rule?
3x3
3x/week x 3 month
Epidural hematoma shape
E= F
Foot ball shape= LOC -> Lucid -> Sudden GCS
versus subdural= crescent
TS Mnemonic
FAT SEGA RASH
- fibroma (ungal, angiofibroma)
- angiomyolipoma of kidney
- tubers (cortical dysplasia)
- subependymal nodules -> risk of change to supependymal giant cell astrocytoma
- retinal hamartoma
- ash leaf (min. 3; 5 mm hypo pigmented)
- shagreen patch
- heart= rhabdomymoma
Minor Criteria: confetti skin, dental pit, intramural fibroma, multiple renal cyst
Confirm Dx via genetic (TSC1 or 2) OR MRI.
MRI and AUS q 1-3 year.
Febrile Seizure age range?
6 mo-6 y.o.
Higher risk if 1d of DTAP or 2 week after MMR.
LP if < 12 month or meningitis.
Risk of febrile sz later= 50%
risk of epilepsy= 2% (vs. 1 % usual)
Higher risk epilepsy= FHX, abnormal neurodevelopment, complex sz (focal, > 15 minute, > 1 sz/24 hour)
NF1 mneomonic
CAFEFOGS
Need min. 2 of 7
- cafe au lait (min. 6; 5mm if prepubertal, 15mm if post pubertal)
- axillary or inguinal freckling
- neurofibroma
- eye: Lisch nodule (min. 2)
- (+) FHX
- optic glioma
- skeletal (cortical thinning, sphenoid dysplasia, pseudo arthroses)
Sturge Weber Syndrome
SKIN- EYES-BRAIN
= port wine V1
= glaucoma
= leptomeningeal angiomas
Breath holding spell age range
Remember same as febrile sz= 6 to 6
6 month- 6 y.o.
Typical 1 minute
cyanotic or pallid
link w/ Fe deficiency
100% resolve by school age
Sinus development saying
Ego Means SelF
= ethmoid (air at birth)
= maxillary (present at birth but air @4)
= sphenoid (air at 5)
= frontal (air at 7-8 but not done till teens)
AOM Criteria
Acute symptom (i.e. otalgia, fever)
+ Middle ear effusion (otorrhea, immobile TM)
+ Inflammation (bulging, colour TM)
if unwell or fever > 39 and otalgia or waited > 48h= treat (Amox x 5 d versus 10d if < 2y.o.)
Tympanostomy Indications
Mastoiditis
Recurrent AOM with middle ear effusion
B/L otitis media > 3 mo. + hearing loss
Absolute indication for tonsillectomy
Obstruction Hemorrhage CA TB Cor pulmonale
Obstructive sleep apnea triad
Sleep disruption
Hypoxemia
Daytime Sleepiness
Sequelae: pul HTN, R+ LVH, cor pulmonale
Recurrent tonsillitis paradise criteria
7 in 1; 5 in 2; 3 in 3
When to bronch a FB:
witnessed episode
object= peanut
P/E findings (wheeze, reduced AE, long expiration)
XR: air trapping or consolidation.
What is an enlarged RPA/cellulitis on XR
soft tissue > 1X width of vertebral body
C2 > 7mm
C6 > 14 mm
Neck mass mnemonic
COIN = congenital = other = infection/ inflam = neoplasm (i.e. SCM tumour)
Malignant node on US
> 1 cm
not echogenic
necrotic
high resistance index
BX if > 2 cm, neonate, firm, supraclavicular, no change x 4 week or B symptoms.
What are the four steps in big picture management of all PID?
Abx - Immunoglobulin – Prophylaxis – HSCT
> Antimicrobial (Tx active infection)
> Immunoglobulin (i.e. IgG for XLA, SCID, Wiskott)
> Prophylaxis (i.e. PCP = Septra for SCID, Wiskott-Aldrich, and CGD, Hyper IgE, Leukocyte adhesion, Pen for Complement)
> Vaccinate (mening + pneumo for Complement) (think complement!)
> HSCT (for combined type SCID, Wiskott, CGD, Leukocyte Adhesion)= cellular + phagocyte!
TIE mnemonic for which PID
Wiskott Aldrich Syndrome
= Thrombocytopenia
= Immunodeficiency (combined; recurrent pyogenic infection)
= Eczema
How do you remember the pattern of immunoglobulin in Wiskott-Aldrich?
Wiskott Whiskey
= EthAnol make Mentation go down
IgE, IgA UP
IgM down
Neuromalignant Syndrome versus Serotonin Syndrome
BOTH autonomic dysf’n
NMS= Hot Lost Rigid
= temp up, altered LOC, muscle rigidity
check CK
Serotonin Syn= HARMED = hyper-Temp = Autonomic = Rigid, DTR ++ = myoclonic jerk, myradiasis = Encephalopathy = DTR ++ or dilated pupil
Shwachman-Diamond Triad
Exocrine pancreas issue (low DAEK)
Cytopenia (neutropenia esp)
Bone (metaphyseal dystosis, thoracic dystrophy, short stature)
Remember: cancer risk (AML)
Meckel’s Diverticulum. Rule of __?
2’s!
2y.o. 2% of population 2X M> F 2 feet proximal to ileoceccal valve 2 inches long 2 mucosa (gastric, pancreatic)
Test: Radionuclide Meckel’s (Tc99 m) scan
Tx: Sx resection
Intussusception triad
Pain-Mass-Blood
Abdominal pain
Palpable Sausage shaped abdo Mass
Bloody currant jelly stool
Celiac Association
Williams T21 Turners T1 DM Sjogren Addison Primary Sclerosing Cholangitis
Pancreatitis Saying
GOTCHA IBD and CF
- IBD
- CF
- Gallstones or biliary slide
- Other= Meds (imuran, steroids, idiopathic)
- Trauma
- Ca2+
- HSP, hyper lipid
- Aziothioprine/Imuran
Intrahepatic biliary atresia or butterfly vertebrae?
Alagille Syndrome
Broad forehead with long straight nose Posterior embryotoxon Conjugated bili Butterfly vertebrae PPHS murmur Pancreatic insufficiency Short
Hep B interpretation rules
Any antigen= infection
C= current or chronic (core ANTIGEN is either; core antibody means chronic!)
GIR formula
% dextrose x TFI / 144
Expected survival for extreme prem BB
22 wk= 20% (1/2 NDD)
23 wk= 40% (1/2 NDD)
24 wk= 60% (1/3 NDD)
25 wk= 80% (1/4 NDD)
Trisomy 18 versus 13 ways to remember?
T18= Eighteen= E= Edward "Tiny cute dysmorphic" - Elongated skull - Digits clenched - Warrior or shield chest - Apnea - Rocker Bottom Feet - Dysplasia feet and low IQ
T13= Patau= PPP= All midline!
- cleft palapte
- dysplastic ears
- polydactyly
- undescended testes
