Pin-point pupil causes

Pin-Point Pupils are due to oPioids and Pontine Pathology

---Anonymous Contributor

Babinski and LMN signs: conditions exhibiting them

"D MASTS":
Diabetes
Motor neuron disease
Ataxia (friedrichs)
Subacute combined degeneration of cord
Tabo paresis
Syringobulbia
---G.S. Dutt

Peripheral neuropathies: differential

DANG THERAPIST:
Diabetes
Amyloid
Nutritional (eg B12 deficiency)
Guillain-Barre
Toxic (eg amiodarone)
Heriditary
Endocrine
Recurring (10% of G-B) Alcohol
Pb (lead)
Idiopathic
Sarcoid
Thyroid
---Ben Campbell University of Otago Medical School, Dunedin, New Zealand

Dementia: some common causes

DEMENTIA:
Diabetes
Ethanol
Medication
Environmental (eg CO poisoning)
Nutritional
Trauma
Infection
Alzheimer's
---Anonymous Contributor

Vertigo: differential
VOMITS:
Vestibulitis
Ototoxic drugs
Meniere's disease

Injury
Tumor
Spin (benign positional vertigo)
---Dr. J.G. Norris

Ramsay-Hunt syndrome: cause and common feature

"Ramsay Hunt":
Etiology:
Reactivated
Herpes zoster
Complication:
Reduced
Hearing
---Rinku S. Uberoi UNIBE

Stroke risk factors

HEADS:
Hypertension/ Hyperlipidemia
Elderly
Atrial fib
Diabetes mellitus/ Drugs (cocaine)
Smoking/ Sex (male)
---Rinku S. Uberoi UNIBE

Multiple sclerosis (MS): epidemiology

MS is a feminine title (Ms.) and is female predominant.
---Anonymous Contributor

Neuropathy: diagnosis confirmation

NEuropathy:
Nerve conduction velocity
Electromyography
---Rinku S. Uberoi

Battle sign
BattlE:
Behind Ear
---Anonymous Contributor

Neurofibromatosis: diagnostic criteria

ROLANDO:
Relative (1st degree)
Osseous fibromas
Lisch nodules in eyes
Axillary freckling
Neurofibromas

Dime size cafe au lait spots

Optic gliomas
---Balraj Jhawar The University of Western Ontario

Proximal myopathy: differential

PEACH PODS:
Polymyositis
Endocrine: hyper, hypothyroidism, Cushing's syndrome, acromegaly
Alcohol
Carcinoma
HIV infection
Periodic hypokalemic paralysis
Osteomalacia
Drugs: steroids, statins
Sarcoidosis
---Anonymous Contributor

Dementia: reversible dementia causes

DEMENTIA:
Drugs/ Depression
Elderly
Multi-infarct/ Medication
Environmental
Nutritional
Toxins
Ischemia
Alcohol
---Mohamed Azim Assistant lecturer of Pediatric Surgery, Alexandria University, Egypt

Stroke: young patient's likely causes

7 C's:
Cocaine
Consanguinity [familial such as neurofibromatosis and von Hippel-Lindau]
Cancer
Cardiogenic embol
hyperCoagulation
CNS infection [eg: HIV conditions]
Congenital arterial lesion
---Samuel Atom Baek-Kim Tuckahoe, N.Y.

Encephalitis: differential
HE'S LATIN AMERICAN:
Herpesviridae
Enteroviridae (esp. Polio)
Slow viruses (esp. JC, prions)
Syphilis
Legionella/ Lyme disease/ Lymphocytic meningoencephalitis
Aspergillus

Toxoplasmosis
Intracranial pressure
Neisseria meningitidis
Arboviridae
Measles/ Mumps/ Mycobacterium tuberculosis/ Mucor
E. coli
Rabies/ Rubella
Idiopathic
Cryptococcus/ Candida
Abscess
Neoplasm/ Neurocysticercosis
Neurocysticercosis should be assumed with recent Latin American immigrant
patient unless proven otherwise.
---Samuel Atom Baek-Kim Tuckahoe, NY

Head trauma: rapid neuro exam

12 P's:
Psychological (mental) status
Pupils: size, symmetry, reaction
Paired ocular movememts
Papilloedema
Pressure (BP, increased ICP)
Pulse and rate
Paralysis, Paresis
Pyramidal signs
Pin prick sensory response
Pee (incontinent)
Patellar relex (and others)
Ptosis
Reevaluate patient every 8 hrs.
---Ernest Boiselier, MD and Sung Kim Attending physician, ISSSTE, Juarez, Mexico

Neurofibromatosis: diagnositic criteria (type-1)

CAFE SPOT:
Cafe-au-lait spots
Axillary, inguinal freckling
Fibroma
Eye: lisch nodules
Skeletal (bowing leg, etc)
Pedigree/ Positive family history
Optic Tumor (glioma)
---Hui-quan Zhao Children's Hospital Cincinnati

Pupillary dilatation (persistent): causes

3AM:
3rd nerve palsy
Anti-muscarinic eye drops (eg to facilitate fundoscopy)
Myotonic pupil (Holmes Adie pupil): most commonly in young women, with
absent/delayed reaction to light and convergence, and of no pathological

significance.
---Gajan Rajeswaran Final Year Medical Student, Imperial College School Of Medicine, London

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.
---Parameswaran Doctor

Huntington's: chromosome, involvement

HUNT 4 DATE:
HUNTington's on chromosome 4, with cauDATE nucleus involvement.
---Syed Medical doctor

Dementia: treatable causes

DEMENTIA:
Drug toxicity
Emotional (depression, anxiety, OCD, etc.)
Metabolic (electrolytes, liver dz, kidney dz, COPD)
Eyes/ Ears (peripheral sensory restrictions)
Nutrition (vitamin, iron deficiencies/ NPH [Normal Pressure Hydrocephalus]
Tumors/ Trauma (including chronic subdural hematoma)
Infection (meningitis, encephalitis, pneumonia, syphilis)
Arteriosclerosis and other vascular disease
---Dr. Bill Lynch, originated by Dr. Jerome Yesavage Palo Alto Veterans Affairs Medical Center

Whipple's disease: features [for neurologists]

A WHIPPLES DOOM:
Arthralgias
Whipplei (organism)
Hypothalamic involvement
Intestinal involvement/ Intestinal biopsy required
PAS positive macrophages
PCR positivity
Lymphadenopathy
Extrapyramidal involvement
Septran treat with
Dementia
Ocular abnormalities (vertical gaze palsy)
Oculomasticatory myorhythmia
Myoclonus
---Bobby Varkey SCTIMST

Congenital myopathy: features

DREAMS:
Dominantly inherited, mostly

Reflexes decreased
Enzymes normal
Apathetic floppy baby
Milestones delayed
Skeletal abnormalities
---Bobby Varkey SCTIMST

Chorea: common causes

St. VITUS'S DANCE:
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
---Bobby Varkey SCTIMST

Status epilepticus: treatment

"Thank Goodness All Cerebral Bursts Dissipate":
Thiamine
Glucose
Ativan
Cerebyx
Barbiturate
Diprivan
---J.D. Broughton, MD

Balint's syndrome
SOOT:
Simultagnosia
Optic ataxia
Ocular apraxia
Tunnel vision
---Bobby Varkey SCTIMST

Visual loss: persistent bilateral sudden onset visual loss differential

FLOP:
Functional
Leber's hereditary neuropathy
Occipital infarctions
Pituitary apoplexy

---Dr. Bobby Varkey SCTIMST

Perinaud's syndrome: clinical features

PERINAUD'S:
Pseudo 6th nerve palsy/ Penial region
Eyelid Retraction
Internuclear ophthalmoplegia
Nystagmus
Accomodation reflex present
Upward gaze palsy
Defective convergence/ Decerebrate rigidity
Skew deviation
---Ram Mohan Svrr Tirupathi AP India

Benidict's syndrome: site affected

Benidict's test for sugar gives red precipitate.
Similarly, Benidict's syndrome affects red nucleus.
---Ram Mohan Svrr Tirupathi AP India

Stroke: basic work up

The 3 P's:
Pump
Pipes
Plasma
---Anonymous Contributor

Neurology Mnemonics
Neurologic Physical Exam
CNS MD
C erebellum and gait
N erves (CN II-XII)
S ensory exam
M otor
D TR (deep tendon reflexes)
DDx of Delirium
MAD HIVES

Neurologic Physical Exam

M etabolic (e.g. liver failure)
A lcohol withdrawal
D rug overdose
H ypoxia (e.g. COPD)
I nfection (e.g. UTI)
V ascular (e.g. CVA)
E pilepsy
S ub-dural hematoma
DDx of Coma
It's COMA
I nfection (e.g. meningitis or sepsis)
T rauma
S eizures
C VA (e.g. stroke)
O verdose (e.g. opioids)
M etabolic (e.g. hypoglycemia, hyponatremia)
A lcohol
Coma Cocktail
TONS
T hiamine
O xygen
N aloxone
S ugar (e.g. D50W)
Glascow Coma Scale
MOVE

Neurologic Physical Exam

M otor assessment
O pen eyes
V erbal assessment
E stimate the score
Diagnosing Meningitis
Don't MISS
M eningeal symptoms (e.g. Kernig and Brudzinski signs)
I ntracranial pressure increase
S eptic symptoms (e.g. fever, tachycardia)
S pinal fluid changes
DDx of Meningitis Causes
BAT
B acterial
A septic (e.g. viral)
TB
Absent Ankle Jerks but Intact Extensor Plantar Response
Sex Can Make The F***ing ankles Dorsiflex
S ubacute combined degeneration of the cord
C onus Medullaris
M otor neuron disease
T abes dorsalis
F riedrich's Ataxia
D iabetic neuropathy
Altered Mental State
AEIOU TIPS

Neurologic Physical Exam

A lcohol
E ndocrine
I nsulin
O piates
U remia
T oxins/trauma/tumor
I nfections
P sychosis/porphyria
S OL/stroke/seizure/shock
Cerebellar Signs
VANISH DDT or PINARDS
V ertigo
A taxia
N ystagmus
I ntention tremor
S lurred speech
H ypotonia
D ysdiadochokinesia
D ysmetria
T itubation
or
P ast-pointing

Neurologic Physical Exam

I ntention tremor
N ystagmus
A taxia
R ebound
D ysdiad
S lurred speech
Confusion
DIM FACES
D rugs
I nfection
M etabolic/MI
F racture
A lcohol
C VA
E lectrolyte disturbances
S .O.L.
Myotonic Muscular Dystrophy
BIG CHIPS
B alding
I ntellectual impairment
G lucose intolerance
C ataracts/Cardiomyopathy
H andshake/hyporeflexia
I gG decreased

Neurologic Physical Exam

P tosis
S mall gonads
Mononeuritis Multiplex
DRAW CLAPS
DM
RA
A IDS
W egeners
C arcinomatosis/Churg-Strauss
L eprosy
A myloid
PAN
S LE
Multiple Sclerosis
CURSED HIV
C erebellar signs
U MN
R etrobulbar neuritis
S pastic paraparesis
E uphoria
D ementia/Depression/Diplopia
H orners
I ncontinence
V ertigo/vomiting
Muscles Supplied by Median Nerve

Neurologic Physical Exam

LOAF
L umbricles
O pp. pollicus
A bd. pollicus
F lex. pollicus brevis
Neuropathic Ulcers
TADS
T abes dorsalis
A lochol
DM
S yringomyelia
Parkinsons
PARKINSONS
P ill rolling tremor
A kinesia
R igidity
K yphosis
I nstability
N eck titubation
S huffling gait
O cculogyric crisis
N ose tap (glabellar)
S mall writing
Peripheral Neuropathy
DANG THE PAPIST

Neurologic Physical Exam

DM
A lcohol
N utrition (e.g. B1, B2, B6, B12)
G uillain Barre syndrome
T rauma
H ereditary (e.g. CMT)
E nvironmental (e.g. lead, drugs)
P araneoplastic
A myloid
P orphyria
I nflammatory
S yphillis
T umors of the nerves (HMSN)
Polyneuropathy
VITAMINS
V itamin deficiency/vasculitides
I nfection (TB, leprosy, syphillis, polio)
T oxins (e.g. amiodarone, antiseptics, INH, lead, metronidazole, phenytoin, vincristine)
A myloid
M etabolic (e.g. EtOH, DM, hyperthyroid, porphyria, liver and renal failure)
I diopathic/inherited
N eoplasm
S ystemic (SLE, PAN, multplie myeloma)

Neurologic Physical Exam

Pontine Hemorrhages
The 3Ps
P aralysis
P in-point pupils
P yrexia
Premature Senile Dementia
DEEP SHIT
D eficiency B12
E pilepsy
E ndocrine
P arkinsonism
S yphilis (GPI)
H untingtons
I njury
T umor
Proximal Myopathy
PD HEN
P olymyositis
D ermatomyositis
H ereditary muscular dystrophies
E ndocrine (e.g. DM, Cushings, Osteomalacia, Thyrotoxicosis)
N europathy
Small Muscle Wasting
MARS BAR
M ND/myopathies

Neurologic Physical Exam

A pical tumors
RA
S yringomyelia
B rachial plexus injuries
A geing
R ib cervical
Syncope
HEAD, HEART & VESS'LS
H ypoglycemia/hypoxia
E pilepsy
A nxiety
D rop attack (e.g. brain stem dysfunction, TIA)
H eart attack
E mbolism
A ortic obstruction (e.g. stenosis, myxoma, IHSS)
R hythm
T achy - VT
V asovagal
E ctopic pregnancy
S ituational (e.g. on the crapper)
S ublclavian steal
L ow SVR (e.g. anaphylaxis, shock, DIC)
S ick sinus syndrome
Wernices and Korsakoffs

Neurologic Physical Exam

CANON
C onfusion
A taxia
N ystagmus
O ccular palsy
N euritis
Pes Cavus
Disease Can Shorten The Foot
DM
C harcot Marie Tooth (CMT)
S yringomyelia
T abes dorsalis
F riedrich's Ataxia
/////

Neurology Mnemonics

Altered Mental State

AEIOU TIPS
Alcohol (drugs),
Endocrine,
Insulin,
Opiates,
Ureamia
Toxins / trauma / tumour,
Infections,
Psychosis / Porphyria,
SOL / stroke / seizure / shock

Cerebellar signs
VANISH DDT

Vertigo,
Ataxia,
Nystagmus,
Intention tremor,
Slurred speech,
Hypotonia
Dysdiadocokinesia,
Dysmetria,
Titubation
or PINARDS
Past-pointing,
Intention tremor,
Nystagmus,
Ataxia,
Rebound,
Dysdiad,
Slurred Speech

Confusion
DIM FACES
Drugs / Dehydration,
Infection,
Metabolic / MI,
Fracture / Failure,
Alcohol / Anaemia,
CVA,
Electrolyte disturbances,
S.O.L.

Dystrophia Myotonica
BIG CHIPS
Balding (frontal),
Intellectual impairment,
Glucose intolerance
Cataracts / Cardiomyopathy,
Handshake / Hyporeflexia,
IgG,
Ptosis,
Small gonads

Mononeuritis Multiplex
DRAW CLAPS
DM,

RA,
AIDS,
Wegeners
Carcinomatosis / Churg-Strass,
Leprosy,
Amyloid,
PAN,
SLE
Multiple sclerosis
CURSED HIV
Cerebellar signs,
UMNL,
Retrobulbar neuritis,
Spastic paraparesis,
Euphoria
Dementia / Depression / Diplopia
Horners,
Incontinence,
Vertigo / Vomiting

Muscles supplied by Median Nerve

LOAF
Lumbricales,
Opp pollicus,
Abd pollicus,
Flex pollicus brevis

Neuropathic Ulcers
TADS
Tabes Dorsalis,
Alcohol,
DM,
Syringomyelia

Parkinsons
PARKINSONS
Pill rolling,
akinesia,
rigidity,
kyphosis,
instability,
neck titubation,

shuffling gait,
occulogyric crisis,
nose tap (glabellar),
small writing

Peripheral neuropathy
DANG THE PAPIST
DM,
Alcohol,
Nutrition (B1, B2, B12),
Guillian Barre
Trauma,
Hereditary,
Environmental (lead, drugs)
Paraneoplastic,
Amyloid,
Porphyria,
Inflammatory,
Syphilis,
Tumours of nerves (HMSN)

Polyneuropathy
VITAMINS
Vit def / vasculitides,
infection (TB, leprosy, syphillis, polio)
Toxins (amiodarone, antiseptics, INH, lead, metronidazole, phenytoin, vincristine)
Amyloid,
Metabolic (alcohol, DM, thyroid, porphyria, liver & renal failure),
Idiopathic / Inherited,
Neoplasm,
Systemic (SLE, PAN, multiple myeloma)

Pontine Haemorrhages
3Ps
Paralysis,
Pin-point pupils,
Pyrexia

Premature senile dementia

DEEP SHIT
Deficiency B12,

Epilepsy,
Endocrine (myxoedema),
Parkinsonism
Syphilis (GPI),
Huntingtons,
Injury,
Tumour
Proximal Myopathy
PD HEN
Polymyositis,
Dermatomyositis,
Hereditary Muscular Dystrophies,
Endocrine (DM, Cushings, Osteomalacia, Thyrotoxicosis - DM COT), Neuropathy

Pupils:
Small HAPPY
Horners,
Argyll-Robertson,
Pontine haemorrhage,
Pilocarpine,
Happy (morphine)

Argyll Robertson SADE

Syphilis,
Alcohol,
DM,
Encephalitis

Small muscle wasting

MARS BAR
MND / Myopathies,
Apical tumours,
RA,
Syringomyelia
Brachial Plexus injuries,
Ageing,
cervical Rib

Syncope
HEAD, HEART & VESSLS
Hypoglycaemia / hypoxia,
epilepsy,
anxiety,
drop attack (brain stem Dysfunction - TIA)
Heart attack,
embolism,
aortic obstruction (stenosis, myxoma, IHSS),
rhythm,
tachy - VT
Vasovagal,
ectopic preg,
situational (on the crapper), subclavian steal,
low SVR (anaphylaxis,shock, DIC), Sick sinus syndrome

Wernickes and Korsakoffs

CANON
Confusion,
Ataxia,
Nystagmus,
Ocular palsy,
Neuritis

Pes Cavus
Disease Can Shorten The Foot
DM
Charcot Marie Tooth
Syringomyelia
Tabes dorsalis
Fredreichs Ataxia
Lethargy, malaise causes
FATIGUED:Fat/ Food (poor diet)
Anemia

Tumor
Infection (HIV, endocarditis)
General joint or liver disease
Uremia
Endocrine (Addison's, myxedema)
Diabetes/ Depression/ Drugs
---The Cashman University of Queensland, Australia
Thickened nerves: causes
HANDS:
Hansen's (leprosy)
Amyloidosis
Neurofibromatosis
Diabetes mellitus
Sarcoidosis
---Dr. Harsh Sharma
Lead poisoning (chronic): features ABCDEFGHI:
Anaemia/ Anorexia/ Arthralgia/ Abortion/ Atrophy of optic nerve
Basophilic stippling of RBC (punctate basophilia)/ Burtonian line on gums
Colic/ Constipation/ Coprophyrin excess in urine/ Cerebraloedema
Drop (wrist, foot)
Encephalopathy/ Emaciation
Foul smell of breath/ Failure of kidneys/ Fanconi syndrome
Gonadal dysfunction/ Gout-like picture
High BP/ Headache/ Hallucination/ Hyperaesthesia
Impotence/ Insomnia/ Irritability
---Dr. Harsh Sharma BJMC, Pune, India
Horner's syndrome: components
SAMPLE:Sympathetic chain injury
Anhidrosis
Miosis
Ptosis
Loss of ciliospinal reflex
Enophthalmos
---Harsh Sharma BJMC, Pune, India
Babinski and LMN signs: conditions exhibiting them
"D MASTS":
Diabetes
Motor neuron disease

Ataxia (friedrichs)
Subacute combined degeneration of cord
Tabo paresis
Syringobulbia
---G.S. Dutt

Dementia: some common causes

DEMENTIA:
Diabetes
Ethanol
Medication
Environmental (eg CO poisoning)
Nutritional
Trauma
Infection
Alzheimer's
Show Details / Rate It
---Anonymous Contributor
Vertigo: differential
VOMITS:
Vestibulitis
Ototoxic drugs
Meniere's disease
Injury
Tumor
Spin (benign positional vertigo)
---Dr. J.G. Norris
Stroke risk factors
HEADS:
Hypertension/ Hyperlipidemia
Elderly
Atrial fib
Diabetes mellitus/ Drugs (cocaine)
Smoking/ Sex (male)
---Rinku S. Uberoi UNIBE

" ALMOST ALL CAUSES OF COMA "

Posted by jawadn on 17-Jul-2006

SaDAM RENTs HIV

S: Systemic Infections e.g. Pneumonia, UTI, Wound Infections
D: Drugs e.g. sedatives, antipsychotics.
A: Alcoholic withdrawal i.e. Delirrium tremens
M: Metabolic e.g Hypoglycemia, HONC, DKA, Hypokalemia, renal failure

R: Raised ICP e.g Tumor, T.B

E: Epilepsy e.g Post iceric phase
N: Nutritional e.g Thiamine (Wernicke's korasakoff's encephalopathy?
T: Trauma e.g head injury

H: Hypoxia e.g respiratory failure

I: Intracranial Infections e.g. meningitis, encepalitis, HSV encephalitis
V: Vascular e.g Stroke, Myocardial Infarction
It really works when u r in A & E and pateint is lying down ahead of you for differential diagnosis and
also in WARD ROUNDS when professor expects bulk of causes from you. There are about 30 causes and
more.....Thanks
by
Dr. Jawad Naseer
BHU Rajowal, Dist. KASUR.

Argyll-Robertson Pupil
Sign of neurosyphilis
"ARP" - Accommodation Reflex Present, but Pupillary Reflex Absent ("PRA" - "ARP"
backwards).
Vertebral/Basilar Ischemia
"4D's"
D izziness (nystagmus)
D iplopia (skew deviation)

D ysarthria
D ysphagia
wernicke's triad
coat=confusion,opthalmoplegia,ataxia due to thiamine deficiency
causes of tetany
CRAMPs
C- hypoCalcemia
R - Respiratory alkalosis
A - Acidosis metabolic
M - hypoMagnesemia
P Porphyria

Ventricular System CSF Flow Sequence Mnemonic!

The order of CSF flow can be difficult to remember, so hope this mnemonic helps.
"Lady Monro has 3 Aqueducts that goes to 4 Luscious and Magical Subarachnoid places."
Lateral Ventricles
Foramina of Monro
3rd ventricle
Cerebral Aqueduct of Sylvius
4th ventricle
Foramina of Luschka & Foramen of Magendie
Subarachnoid Space
From here the CSF goes to the arachnoid granulations and into the superior saggital sinus (filled
with venous blood)

Normal Range
Appearance Clear & colourless
White Cells 0 5 x 106 per litre (all lymphocytes with no neutrophils)
Red Cells 0 10 x 106 per litre
Protein 0.2 0.4 grammes per litre (or less than 1% of the serum protein concentration)
3.3 4.4 mmol per litre (or 60% of a simultaneously derived plasma glucose
Glucose
concentration)
7.31
pH
Pressure 70 180 mmH2 O
The changes in various conditions are given below:

Condition

Appearance

Bacterial Meningitis Cloudy & Turbid

Viral Meningitis
Tuberculous Meningitis
Subarachnoid
Haemorrhage
Guillan-Barr
Syndrome
Multiple Sclerosis

White Cells
Raised
neutrophils
Raised
lymphocytes
Raised
lymphocytes

Red
Cells

Protein

Glucose

H or VH

VL

N or H

N or L

H or VH

VL

VH

N or H

N or L

H (only after 1
week)

N or L

Raised
lymphocytes

N
N or slightly
cloudy
Usually blood
stained

VL = Very Low
L = Low
N = Normal
H = High
VH = Very High

Pediatrics Mnemonics
Pediatrics Mnemonics

Gastroschisis: usual location GasTRoscHIsis

usually occurs on the
RIGHT side of the umbilicus.
(Unscramble the letters).

Milk protein: women vs. cows Woman: Whey

(mostly)
Cow: Casein (mostly)

Short stature: differential ABCDEFG:

Alone (neglected infant)
Bone dysplasias (rickets, scoliosis, mucopolysaccharidoses)
Chromosomal (Turner's, Down's)
Delayed growth
Endocrine (low growth hormone, Cushing's, hypothyroid)
Familial
GI malabsorption (celiac, Crohn's)

Breast feeding: contraindicated drugs BREAST:

Bromocriptine/ Benzodiazepines
Radioactive isotopes/ Rizatriptan
Ergotamine/ Ethosuximide
Amiodarone/ Amphetamines
Stimulant laxatives/ Sex hormones
Tetracycline/ Tretinoin

Paediatric history taking Begin with standard things:

patient name, presenting complaint, history of presenting complaint and past
medical history.
Then ask BIFIDA:
Birth details and problems
Immunisations
Feeding
Infection, exposure to
Development, normality of
Allergies
End by customary review of the rest of the standard things: medications,
family history and social history.

APGAR score components APGAR:

Appearance: cyanosis--peripheral, central, none
Pulse: pulse rate
Grimace: response to stimulation

Activity: movement of the baby (muscle tone)

Respiration: respiratory rate

Beckwith-Widemann syndrome: features HOMO:

Hypoglycemia
Omphalocel
Macroglossia/ Macrosomia
Organomegaly

Neonatal resuscitation: successive steps "Do What

Pediatricians Say To, Or Be Inviting
Costly Malpractice":
Drying
Warming
Positioning
Suctioning
Tactile stimulation
Oxygen
Bagging
Intubate endotracheally
Chest compressions
Medications

APGAR score components Five B's:

Breathing (respiratory effort)
Beating (heart rate)
Buff (tone)
Bothered (response to stimulation)
Blue (cyanosis)

Cystic fibrosis: exacerbation of pulmonary infection CF

PANCREAS:
Cough (increase in intensity and frequent spells)
Fever (usually low grade, unless severe bronchopneumonia is present)
Pulmonary function deterioration
Appetite decrease
Nutrition, weight loss
CBC (leukocytosis with left shift)
Radiograph (increase overaeration, peribronchial thickening, mucus
plugging)
Exam (rales or wheezing in previously clear areas, tachypnea,
retractions)
Activity (decreased, impaired exercise intolerance, increased
absenteeism)
Sputum (becomes darker, thicker, and more abundant, forming plugs)

Pyloric stenosis (congential): presentation Pyloric

stenosis is 3 P's:
Palpable mass
Paristalsis visible
Projectile vomiting (2-4 weeks after birth)

Cyanotic heart diseases: 5 types 5 T's:

Tetralogy of Fallot
Transposition of the great arteries
Truncus arteriosus
Tricuspid atresia, pulmonary aTresia
Total anomalous pulmonary venous drainage

Breast feeding: benefits ABCDEFGH:

Infant:
Allergic condition reduced
Best food for infant
Close relationship with mother

Development of IQ, jaws, mouth

Mother:
Econmical
Fitness: quick return to pre-pregnancy body shape
Guards against cancer: breast, ovary, uterus
Hemorrhage (postpartum) reduced

Perez reflex Eliciting the PErEz reflex will

make the baby PEE.

WAGR syndrome: components WAGR:

Wilm's tumor
Aniridia
Gential abnormalities
Mental retardation

Haematuria: differential in children ABCDEFGHIJK:

Anatomy (cysts, etc)
Bladder (cystitis)
Cancer (Wilm's tumour)
Drug related (cyclophosphamide)
Exercise induced
Factitious (Munchausen by proxy)
Glomerulonephritis
Haematology (bleeding disorder, sickle cell)
Infection (UTI)
In Jury (trauma)
Kidney stones (hypercalciuria)

Vitamin toxicities: neonatal Excess vitamin A: Anomalies

(teratogenic)
Excess vitamin E: Enterocolitis (necrotizing enterocolitis)
Excess vitamin K: Kernicterus (hemolysis)

Rubella: congenital signs "Rubber Ducky, I'm so blue!"

(like the "Rubber Ducky" song):
Rubber: Rubella
Ducky: Patent Ductus Arteriosus, VSD and pulmonary artery stenosis.
I'm: Eyes (cataracts, retinopathy, micropthalmia, glaucoma).
Blue: "Blueberry Muffin" rash (extramedullary hematopoesis in skin
+purpura)
Also, deafness, growth retardation, and some more.

Pediatric milestones in development 1 year:

-single words
2 years:
-2 word sentences
-understands 2 step commands
3 years:
-3 word combos
-repeats 3 digits
-rides tricycle
4 years:
-draws square
-counts 4objects

Williams syndrome: features WILLIAMS:

Weight (low at birth, slow to gain)
Iris (stellate iris)
Long philtrum
Large mouth
Increased Ca++
Aortic stenosis (and other stenoses)

Mental retardation
Swelling around eyes (periorbital puffiness)

Russell Silver syndrome: features ABCDEF:

Asymmetric limb (hemihypertrophy)
Bossing (frontal)
Clinodactyly/ Cafe au lait spots
Dwarf (short stature)
Excretion (GU malformation)
Face (triangular face, micrognathia)

Dentition: eruption times of permanent dentition "Mama

Is In Pain, Papa Can Make Medicine":
1st Molar: 6 years
1st Incisor: 7 years
2nd Incisor: 8 years
1st Premolar: 9 years
2nd Premolar: 10 years
Canine: 11 years
2nd Molar: 12 years
3rd Molar: 18-25 years

Cyanotic heart diseases: 5 types Use your five fingers:

1 finger up: Truncus Arteriosus (1 vessel)
2 fingers up: Dextroposition of the Great Arteries (2 vessels
transposed)
3 fingers up: Tricuspid Atresia (3=Tri)
4 fingers up: Tetralogy of Fallot (4=Tetra)
5 fingers up: Total Anomalous Pulmonary Venous Return (5=5 words)

Cyanotic congenital heart diseases 5 T's:

Truncus arteriosus
Transposition of the great arteries
Tricuspid atresia
Tetrology of Fallot
Total anomalous pulmonary venous return

Head circumference with age Remember 3, 9, and multiples

of 5:
Newborn 35 cm
3 mos 40 cm
9 mos 45 cm
3 yrs 50 cm
9 yrs 55cm

Weights of children with age Newborn 3 kg

6 mos 6 kg (2x birth wt at 6 mos)
1 yr 10 kg (3x birth wt at 1 yr)
3 yrs 15 kg (odd yrs, add 5 kg until 11 yrs)
5 yrs 20 kg
7 yrs 25 kg
9 yrs 30 kg
11 yrs 35 kg (add 10 kg thereafter)
13 yrs 45 kg
15 yrs 55 kg
17 yrs 65kg

Hemolytic-Uremic Syndrome (HUS): components "Remember to

decrease the RATE of IV fluids in these patients":
Renal failure
Anemia (microangiopathic, hemolytic)
Thrombocytopenia
Encephalopathy (TTP)

Cough (chronic): differential When cough in nursery, rock

the "CRADLE":
Cystic fibrosis
Rings, slings, and airway things (tracheal rings)/ Respiratory
infections
Aspiration (swallowing dysfunction, TE fistula, gastroesphageal reflux)
Dyskinetic cilia
Lung, airway, and vascular malformations (tracheomalacia, vocal cord
dysfunction)
Edema (heart failure)

Cystic fibrosis: presenting signs CF PANCREAS:

Chronic cough and wheezing
Failure to thrive
Pancreatic insufficiency (symptoms of malabsorption like steatorrhea)
Alkalosis and hypotonic dehydration
Neonatal intestinal obstruction (meconium ileus)/ Nasal polyps
Clubbing of fingers/ Chest radiograph with characteristic changes
Rectal prolapse
Electrolyte elevation in sweat, salty skin
Absence or congenital atresia of vas deferens
Sputum with Staph or Pseudomonas (mucoid)

Sturge-Weber syndrome: hallmark features Sturge-Weber:

1. Seizures
2. PortWine stain

Guthrie card: diseases identified with it "Guthrie

Cards Can Help Predict Bad Metabolism":
Galactosaemia

Cystic fibrosis
Congenital adrenal hyperplasia
Hypothyroidism
Phenylketonuria
Biotidinase deficiency
Maple syrup urine disease

Croup: symptoms 3 S's:

Stridor
Subglottic swelling
Seal-bark cough

Ataxia-Telangiectasia (AT): common sign AT:

Absent
Thymus

Cerebral palsy (CP): most likely cause CP: Cerebral

Palsy
Child Premature
The premature brain is more prone to all the possible insults.

Vacterl syndrome: components VACTERL:

Vertebral anomalies
Anorectal malformation
Cardiac anomaly
Tracheo-esophageal fistula
Exomphalos (aka omphalocele)
Renal anomalies
Limb anomalies

Guthrie card: diseases identified with it GUTHRIE:

Galactosaemia
Urine [maple syrup urine disease]
THyRoid [hypothyroidism]
Inborn Errors of metabolism [eg: PKU]

Duodenal atresia vs. Pyloric stenosis: site of obstruction

Duodenal Atresia: Distal to Ampulla of vater.
Pyloric stenosis: Proximal to it.

Bilirubin: phototherapy BiLirUbin

absorbs light maximally in the
BLUe range.

Septic Arthritis: most common cause Staphylococcus

Aureus is the most common cause of
Septic Arthritis in the pediatric population.

2 much Scotch leads to cirrhosis

Liver function tests in cirrhosis:
AST/ALT ratio greater than 2:1 suggests alcohol-induced cirrhosis.
Phillip Parmet

A MUDPILE CAT
Causes of Anion gap metabolic acidosis:
Alcohol, Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde Iron/Isoniazid, Lactic acidosis,
Ethylene glycol, Carbamazepine, Aspirin, Toluene
Hasan Usmani

A PIE SAC

Extraintestinal manifestation of inflammatory bowel disease:

Aphthous ulcers, Pyoderma gangrenosum, Iritis, Erythema nodosum, Sclerosing cholangitis,
Arthritis, Clubbing.
Fahad Aljaser

A Special Man Should Think Perceptive Clever INSIGHTs

Psychiatry - Mental State Examination:
Appearance and behavior, Speech, Mood, Suicidality and dangerousness, Thoughts, Perception,
Cognition, INSIGHT (into condition).
Dilshad Marikar

ABCDE
Portal hypertension features:
Ascites, Bleeding (hematemesis, piles), Caput medusae, Diminished liver, Enlarged spleen
Rudaina Hassan

AMPLE
Key questions needed in an emergency history taking situation:
Allergies, Medication, Past medical history, Last meal, Events and environment related to injury
Helen Fenwick

APPENDICITIS
Differential for RLQ pain:
Appendicitis, PID/Period, Pancreatitis, Endometriosis/Ectopic pregnancy, Neoplasia, Diverticulitis,
Intussusception, Cyst (ovarian), Inflammatory bowel disease (Crohn's), Torsion (ovary), Irritable
bowel syndrome, Stones
Phillip Parmet

Babies Hate Pediatricians Because Pain is Inevitable

Causes of neonatal jaundice between 24 hours to 2 weeks:
Breast milk jaundice, Haemolysis, Physiological, Bruising, Polycythemia, Infection (e.g. UTI)
Dilshad Marikar

BEASTIAL - Treatments for pediatric eczema

Fight fire with fire - a "BEASTIAL" cure for a beastial disease.
Bandages to prevent scratching, Emolients, Antibiotics or antifungals, Steroids, Tacrolimus an
immunomodulator, Irritant avoidance wool, etc., Allergen avoidance foods, etc., "Lop" off nails Okay, so the last one is a bit tenuous by using the word "lop" but there again it is also one of the
most memorable exactly because of this and good nail care remains an important way of preventing
excoriation of itchy lesions. This little mnemonic created by me and a friend while bored in a library
helped a good few of us sail through our fourth year OSCE, after being asked the question "list 7
treatments for childhood eczema"!
Leach Paul

Can I Buy Rancid Orange Apricots Mummy?

Classes of drugs used for tocolysis with an example of each:
Cyclooxygenase inhibitors: Indometacin, Beta-sympathomimetics: Ritodrine or Salbutamol,
Oxytocin antagonist: Atosiban, Magnesium sulphate
Dilshad Marikar

Can I Make Tea?

Types on miscarriage:
Complete, Incomplete, Missed, Threatened.

Dilshad Marikar

Capital sin: WRATH

Dependence ICD-10 = 3 of the following at some time during last year:
1. Compulsion or strong desire to take the substance.
2. physiologic Withdrawal of state when the substance has stopped or been reduced.
3. difficulty Refraining from using the substance, stopping using it,or limiting the amount taken.
4. progressive neglect of Alternative pleasures or interests because of psychoactive substance use
and increased amount of time necessary to obtain or take the substance or to recover from its effects.
5. evidence of Tolerance, a state in which increasing doses of the substance are required to produce
the effect originally produced by lower doses.
6. persistent use despite clear evidence of Harm.
Chik Wai Ho

CHAOS
anaphylaxis management:
Chlorphenamine Hydrocortisone Adrenaline Oxygen Salbutamol
Nur Hafiz Izzate Hassmoro

Compulsive CONTROLLING Widows Tolerate Neglected Pensioners

ICD-10 criteria for substance dependence syndrome:
Compulsion to take the substance, difficulties in Controlling substance-taking behavior,
Withdrawal state physiological when substance reduced or ceased, Tolerance, Neglect of other
interests/activities, Persistence in spite of awareness of harmful consequences.
Dilshad Marikar

CRAP: Rheumatology
Rheumatology, the seronegative spondyloarthropathies: C-Colitic R- Reactive A-Ankylosing
Spondylitis P-Psoriatic
Moe Alam

DANISH
Cerebellar signs:
Dysdiachokinesis, Ataxia, Nystagmus, Intension tremor, Slurred speech and Hypotonia
Laura Troth

DDDD - Signs of niacin B3 deficiency Pellegra

Dermatitis, Dementia, Diarrhea, Death
Esben Vogelius

DEATH
Activities of daily living: Dressing, Eating, Ambulating, Toileting, Hygiene
Esben Vogelius

FAINT DAMN
Local causes of epistaxis:
Foreign body, Atmospheric changes, Infection, Neoplasm of nose and paranasal sinuses, Trauma,
Deviated nasal septum, Adenoiditis, Malignant tumors, Nasopharyngeal angiofibroma
ritesh bhoot

Finding Courteous Cuddly Paediatricians Is Never Easy, Dr Cuddles

Causes of short stature in children:
Familial, Constitutional delay of growth and puberty, Chronic illness, Psychosocial, Intra-uterine

growth restriction and prematurity, Nutrition, Endocrine, Disproportionate short stature,

Chromosomal
Dilshad Marikar

GAMED
To Remember Immunoglobulins:
IgG, IgA, IgM, IgE, IgD
Muhammad Ilyas

I GET SMASHED
Causes of acute pancreatitis:
Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune diseases, Scorpion stings,
Hypertriglyceridemia, ERCP, Drugs (e.g. azathioprine, diuretics).
Fahad Aljaser

In Toronto People Can Really Sing

Rules for a neurological examination of the limb:
Inspection, Tone, Power, Coordination, Reflexes, Sensation
Laura Troth

LEAD
Signs of lead poisoning Lead lines in gingiva, Erythrocyte stippling, Abdominal pain, Drop foot, wrist
Esben Vogelius

LEAF
Lifestyle changes for hypertriglyceridemia:
Lower meat intake Exercise regularly Avoid alcohol Fat-restricted diet
John Collins

Lichen Planus = Lots of Ps

Adding to the commonly known 5 p's pruritic, planar, purple (or pearly pink), polygonal papules, i
thought it was important to add plaques, Pride and Prejudice [in reference to Wickham's Striae and
Old Mr. Wickham of Pride and Prejudice], and Picard [in reference to Startreck Jean luc Picard's
localised alopecia]
Aaron MIlls

Limbic System: Five functional F's

Feeding, Feeling, Fleeing, Fighting, and 'Sex'
Phillip Parmet

LMNOP
Treatment of Pulmonary Edema:
Lasix, Morphine, Nitroglycerin, Oxygen, Prop up the patient
AWAIS AHMAD

LOSE
ICD-10 criteria for anorexia:
Low body weight BMI 17.5, Overvalued idea - dread of fatness, Self-induced weight loss,
Endocrine disturbance.
Dilshad Marikar

LP Thomas Knows Best

Malignancies that metastisize to bone:

Lung, Prostate, Thyroid, Kidney, Breast

Victoria Chedgey

MAD SCAB
Aneurysm types:
Mycotic, Atherosclerotic, Dissecting, Syphilitic, Capillary microaneurysm, Arteriovenous fistula,
Berry
Rudaina Hassan

MAGED
Immunogloblin subtybes:
IgM, IgA, IgG, IgE, IgD.
Maged is an arabic name and therefore was a good method to remember the subtypes when I was in
the first year of medical college.
abdul rahman

Make Every Child Cry

Causes of opacity on chest x-ray:
Mass, Effusion, Consolidation, Collapse
Dilshad Marikar

MALT
Walls of the inguinal canal:
Muscles (external oblique, internal oblique, transversus abdominis)
Aponeuroses (external oblique, internal oblique)
Ligaments (inguinal, lacunar)
Transversalis fascia
Sarah Gates

Must Lower Hypertension Now Matron

Drug treatment for preeclampsia:
Methyldopa, Labetalol, Hydralazine, Nifedipine, Magnesium sulphate
Dilshad Marikar

My Light Cramping Period Is Painful - CONTRACEPTION Can Often Soothe U People

Some of the specific essential questions that ought to be asked in a gynecological history:
Menstrual questions, Last menstrual period, Cycle, Postcoital bleeding, Intermenstrual bleeding,
Postmenopausal bleeding, Contraception, Cervical smear, Obstetric history, Sexual questions (e.g.
deep/superficial dyspareunia), Urinary questions, Prolapse questions.
Dilshad Marikar

NPI GPS
G NPI S The Nottingham Prognostic Index guides one like a GPS in determining breast cancer
prognosis. It has 4 key components. N for Lymph Node involvement G for Tumour Grade S for
tumour size in cm I for Lymphovascular Invasion Writing NPI horizintally and GPS vertically helps
one remember the 4 key components.
George Alex

Oh Oh Oh! To Touch And Feel Very Good Velvet, Absolute Happiness!

For remembering the order of the cranial nerves:
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear,
Glossopharyngeal, Vagus, Accessory, Hypoglossal
Kara Towles

On Old Oscar's Table Top A Feisty Virgin Gets Vivacious And Hot!
CRANIAL NERVE NAMES: Olfactory CN I, Optic CN II, Occulomotor CN III, Trochlear CN IV,
Trigeminal CN V, Abducens CN VI, Facial CN VII, Vestibulo-Chochlear CN VIII, Glasopharyngeal
CN IX, Vagus CN X, Accessory CN XI, Hypoglossal CN XII
David Jones

OPQRST
Part of the patient assessment of a symptom (e.g. chest pain or abdominal pain):
Onset of event, Provocation (or palliation), Quality of pain, Radiation (and region), Severity, Time
(history)
Evelyn Kamgang

Orange Orangutans Often Try To Avoid Feeding Vicious Gorillas Very Smelly Haggis
The cranial nerves:
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear,
Glossopharyngeal, Vagus, Spinal root of the accessory, Hypoglossal.
Rebecca Ward

PAINED VICTIMS
Differential Diagnosis checklist:
Psychiatric, Autoimmune, Infectious, Neoplastic, Endocrine, Drugs,
Vascular, Inflammatory, Congenital, Traumatic, Iatrogenic, Metabolic, Social
Neil Gray

PEST
What to look for in a limb when suspecting DVT:
Pain, Erythema, Swelling, Tenderness
Dilshad Marikar

PIAO HAS RED CAPS

Causes of Amenorrhoea:
Pregnancy, Intersexuality, Anorexia nervosa, Ovarian insufficiency, Hypogonadotrophic
amenorrhoea, Anovulation, Secondary hypothalamic dysfunction, Resistant ovarian syndrome,
Ectopic pregnancy, Delayed puberty, Chiari-frommel syndrome, Asherman's syndrome,
Pseudocyesis, Sheehan's syndrome
Marziyah Outim

PLANS
Indications for nasogastric tube feeding:
Perioperative, Lavage, Aspiration, Nutrition, Swallowing problems
Dilshad Marikar

RAGS
Causes of Jaundice at 24 hours of age:
Rhesus incompatibility, ABO incompatibility, G6PD deficiency, Spherocytosis
Dilshad Marikar

RICE
The principles of treatment in soft-tissue injuries, especially muscular injuries: Rest, Ice,
Compression, Elevation
Parmeseeven Mootoosamy

SAW EMAIL

Features of depression:
Sleep disturbance, Appetite, Weight, Energy, Mood, Activity, Interests, Libido
Esta Jiad

Signs of HUS - RAT

R - Renal abnormalities; A - Anemia Hemolytic; T - Thrombocytopenia
Esben Vogelius

Signs of TTP - FAT RN

F - Fever; A - Anemia Hemolytic; T - Thrombocytopenia; R - Renal abnormalities N - Neurolgical
abnormalities
Esben Vogelius

Six "S" in Scarlet Fever

Streptococci causal organism, Sorethroat, Swollen tonsils, Strawberry tongue, Sandpaper rash,
miliarySudamina vesicles over hands, feet, abdomen
Than Hein

SLUD - signs of anti-cholinergic crisis

Salivation, Lacrimation, Urination, Defecation
Esben Vogelius

SPACE TITS
Examination of a swelling:
Size (and shape), Position (and pulsation), Attachments, Consistency, Edges, Transillumination,
Inflammation (and temperature, erythema, pain), Thrills (and bruits), Surface
Aaron MIlls

The 12 Cranial Nerves of Christmas

On the 12th day of Christmas the Doctor dissected for me...
One hypoglossal,
Another one called facial,
A decorated abducens,
A drunk trochlear,
A wrapped oculomotor,
A very merry vagus,
A festive vestibulocochlear,
TRRRRRRIIIIIIGGGGGEEEEEMMMINALLLL!
Glossopharyngeal,
Accessory,
An olfactory
AND AN OPTIC NERVE SO I CAN SEE!
Ashley Tilston

The three big "M"s

Causes of huge spleen are:
Myelofibrosis, Malaria, Myelogenous leukemia
Sharaf Karim

TRAP
Cardinal Symptoms of Parkinson's Disease:
Tremor, Rigidity Akinesia and bradykinesia, Postural Instability

Joanne Evans

TWO MAFIA
Causes of persistent fistula or sinus:
Tuberculosis, Worm (rare but occurs), Obstruction, Malignancy, Absence of rest, Foreign body,
Inadequate drainage, Actinomycosis
Sharaf Karim

Two Zebras Bought My Car

Terminal branches of the facial nerve: VII Temporal, Zygomatic, Bucccal, Marginal mandibular,
Cervical
Roshini Kulanthaivelu

VAL has an ectopic pregnancy

Triad: Vaginal Bleeding; Amenorrhea; Lower Abdominal Pain.
HA PHAM

Very Sick Patients Must Take Double Exercise

Days of appearance of rashes
Varicella (chickenpox)- 1st day
Scarlet fever - 2nd day
Pox (smallpox) - 3rd day
Mumps - 4th day
Typhus - 5th day
Dengue - 6th day
Enteric fever (typhoid) - 7th day
tapojyoti das

VICES
Causes of pulmonary arterial hypertension:
Vasculitis; Idiopathic primary pulmonary hypertension; COPD; Emboli; Shunt Eisemenger's
syndrome
Phillip Parmet

Vodka Is The Coolest Drink Said The Lady Sitting Plastered At Bar
For remembering upper extremity arterial branches off of the subclavian/axillary/brachial artery:
Vertebral, Internal thoracic, Thyrocervical, Costocervical, Dorsal scapular, Supreme thoracic,
Thoracoacromial, Lateral thoracic, Subscapular, Posterior circumflex humeral, Anterior circumflex
humeral, Brachial
Kara Towles

weak FLEA!
To help remember the upper motor lesion weakness pattern (weaker extensors in upper limb and
weaker flexors in lower limbs):
weak
Flexors(Legs), Extensors(Arms)

How to remember the basic framework of the Glasgow

coma scale?

Eye opening: 4 eyes (glasses)

Motor: 6 cylinder engine
Verbal: Jackson 5

Gives you a total of 15. (A brick has a

GCS of 3)

ABG made simple

Watch this video to simplify the understanding of Respiratory / metabollic alkalosis / acidosis.

Alkaline phosphatase elevated - Bone origin or Liver origin?

The mnemonic was revealed when I got a patient with very high Alkaline phosphatase who had no clear
cut evidence of bone / GI disease. So I read through the various tests to differentiate between ALP of
Bone and Liver origin. There were various tests including GGT, Heat stability, Bone scan, Ct scan.... etc
etc. But the point of Heat stability of ALP of liver origin has this interesting code:
Bone Burns first, Liver Lasts / LIVEs
Explanation : ALP of Bone origin is heat labile (Burns), while that of Liver origin is heat stable (Lasts /
Lives).

Tuesday, March 23, 2010

VDRL : False Positive cases
VDRL is false positive in "Missed Positive VDRL"
Malaria
Pregnancy
Viral diseases - Hepatitis, IMN
Drugs
Rheumatic fever, Rheumatoid arthritis
Leprosy, Lupus

Orthopaedic investigations : Table

Memorising this table will help to differentiate the above orthopaedic conditions.

Micro organisms which don't Gram stain well

List of Microbes which may not gram stain well:
Remember: " These Microscopic Rascals May Look Colourless "
Treponema
Mycobacteria
Rickettsia
Mycoplasma
Legionella
Chlamydia
Blood group
O Negative (O -ve) blood group is universal dONor
BT, CT, PT, PTT
Bleeding time gives Platlet response ( Remember BP )
Clotting time gives idea about Coagulation pathway ( Remember CC )
Also remember the following about Prothrombin Time (PT) and Partial Thromboplastin Time (PTT):
PTT - Intrinsic and common pathway

PT - Extrinsic and common pathway

( Remember this by imagining that Peter is going to take part in a Tea drinking contest. To be IN to the
contest Peter must drink two Teas (TT) - PTT gives idea about INtrinsic and common pathway. If Peter
drinks only one T, he is OUT = Extrinsic and common pathway represented by PT )
LFT : SGOT vs SGPT, Direct BR vs Indirect BR
SGOT = AST, SGPT = ALT
SGOT is elevated in alcholic hepatitis.

I always get confused between the two. Here's how to remember: When you drink alcOHOL,
you get hepatitis and your liver gets HOLes. So there are more HOLEs in SGOT - That's why
SGOT is present in mitOchOndria and cytOsOl. SGPT is present only in cytosol.
To remember SGOT = AST and SGPT = ALT, strike out the common letters on both sides. You
get O = S and P = L. Now remember "The OS (operting system) of your life gets corrupted with
alchol". Remember OS for O=S --> SGOT = AST.
The other confusion is between Direct and Indirect bilirubin. Which is more? The level of Indirect is more
- remember the number of letters in 'Indirect' are also more as compared to 'Direct'. Indirect
= Unconjugated BR. ( Note that both have prefixes ). Therfore, Direct = Conjugated BR.
Normal Differential Count Values

WBC Differential Count (DC) :

Remember :"Never Let Monkeys Eat Bananas" and "60, 30, 6, 3, 1"
Neutrophils 60%
Lymphocytes 30%
Monocytes 6%
Eosinophils 3%
Basophils 1%
Sodium and Potassium

Sodium is EXtracellular, Potassium INtracellular (SEX, PIN)

What are normal values of Sodium and Potassium in serum ? They are 135 - 145 and 3.5 - 5.5
respectively. I used to get confused between these values when I first heard them. This is how I
remembered it: Sodium is EXTRAcellular - has EXTRA values, so the larger value is for it - that
is 1-3-5, the first three odd numbers and for the smaller potassium, take only second & third odd
numbers i.e. 3-5, make it to 3.5
Posted by Dr. Shajil at 9:22 PM 0 comments

Labels: Biochemistry, Laboratory, physiology

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Iron content in body and in milk

Total quantity of " I R O N " in human body is 4 gms (= number of letters inthe word " I R O N
")
Iron content in Milk = 0.4 mg
Microbiology - Special Stains

You know Gram stain is for Bacteria, Acid Fast for Mycobacterium (also Nocardia). Remember other
special stains below:

Giemsa : CAmpylobacter, Malaria, Leishmaniasis (CAMeL) (Remember the picture of Giemsa Camel
above)
Silver stain : pNEumocystis (CARnii), FUNgi, LEGionella (Remember the picture above : it's a SILVER NEW
CAR with FUNny LEGs)
MuciCaRmine - CRyptococci
Periodic Acid Schiff: FUNgi, amoeba (A FUNny amoeba just PASsed away)

Neurological Examination
1. C O M CI:

Conscious level of conscious.

Oriented To time, place and person.
Mentality:
i.
ii.

Infant from speech & Sphincteric control.

Late childhood from school achievement.

Co-operative.
Intelligence.

2. Motor system "the most important issue":

State of muscles:
Wasting "Bilateral or Unilateral / Proximal or Distal".
Hypertrophy "compare Left to Right".

 Pseudo-hypertrophy Duchenne.
Normal.

Abnormal movements:

Fasciculation.
Involuntary movements as chorea.

Tone:

The Tone Elicited by:

Flexion & extension of the elbow & knee.

Passive by:

Shaking method of wrist & ankle.

Active: against resistance.

Gower test: for the shoulder.
The Results:
Hypotonia LMNL.
Hypertonia UMNL.

Power:

If the patient is co-operative as it need resistance from the Pt.:

Shoulder abduction & adduction against resistance.

UL

Flexion & extension of elbow & wrist against resistance.

Finger abduction & adduction against resistance:

Fist making:

Flexion & extension of knee & hip against resistance.

Abduction & adduction of the knee & hip against resistance.
LL
Dorsiflexion & planter flexion against resistance.
Degree of power:
i.
No movement at all.
ii.
Horizontal movement.
iii.
Movement against gravity.
iv.
As above + can carry an object.

Reflexes:

Superficial reflexes:
1. Planter reflex (S1):
Scratching the outer aspect of the sole of the foot using a key. "

"
Normally: planter flexion.
Abnormally: +ve Babinski Dorsiflexion + Fanning "normal up to
1 year".

2. Abdominal reflex (T6-T12):

Scratch the abdomen by blunt object from the flanks towards
umbilicus.
Normal response: shift of the umbilicus towards the site of
scratching.

3. Cremastric reflex (L1):

Stroke the medial aspect of the thigh

4. Gluteal reflex (L4, 5).

elevation of the tes

5. Anal reflex (S3, 4, 5).

Deep reflexes "hyper-reflexia, hypo-reflexia": Hummer

1. Biceps (C5,6):

UL

Elbow at angel 120.

Put your finger on the biceps tendon and hit on it.
Don't forget to expose the whole muscle while you are doing the test,
to see the response.
Response: flexion of elbow or just fine contraction of the biceps is
seen.

2. Triceps (C6,7):

Elbow at angel 90.

Hit the tendon directly.
Response: extension of the elbow, or just contraction of the muscle.

3. Knee (L2,3,4)
LL

Angel of the knee 90.

Hit the quadriceps tendon "between patella & tibial tuberosity"
Quadriceps contraction.

4. Ankle (S1)

Angel of ankle: 90 & Angel of knee: 120.

Hit on tendon Achilles contraction of calf muscles.

Clonu
Hold the foot of the baby.
Do sudden maintained Dorsiflexion.
Response: Regular Rhythmic movements of the foot "Clonus".

Neonatal reflexes:
Moro reflex.
Its presence beyond 6 months CP MR.

Function

.UL

.
LL

3. Sensory system "reading":

Superficial:
Pain by needle.
Touch by cotton.
Temp. by cold or hot water.

Deep:
Vibration sense by tuning fork.
Muscle & joint sense ,

.
Cortical:
Tactile localization.

2 point discrimination.
Sterognosis.
Graphesthia.

4. Coordination (ataxia): cerebellum "reading"

Nystagmus.
Staccato speech.
Head nodding.
Finger to nose / finger to finger test.

5. Cranial nerves: "the 2nd important issue"

i.

Olphactory:
Close his eyes & close one nostril.
Introduce a familiar material to smell (perfume, coffee).
Response: working ala nasi & identification of the smell.

ii.

Optic:
Visual acuity:
2-3 months fix & follow object.
7-8 m reach object.

"
2 years

9-10 m Pincer graft "thump & index

Older Counting fingers-hand motion.

Visual field:

Sit opposite to the child, your eyes at the same level, bring
object from beyond field of vision, ask child to say yes when he
sees object.

Pupil for light reflex.

iii.
iv.
v.

Occulomotor.
Trochlear.
Abducent. "6th"

vi.

Trigeminal: "5th"
Motor
part
Sensory
part

vii.

Extra ocular muscle test

Fix patient's head; Ask him to follow the torch in

the 6 Cardinal directions if fails Squint

Temporalis & Maseter muscles.

Med. & Lat. Pterygoids.

Chewing.
Try to touch either side of the face with cotton while the child
closes his eyes.

Facial:
Inspecting the facial expression of the baby especially during cry.

. , ,
viii.

Vestibulocochlear:
Apply loud sound near his ear turns face towards the sound.

ix.

Glossopharyngeal.

x.

Vagus.

Gag & palatal reflex by tongue depressor.

Uvula ask Pt. to say Aah uvula deviates to the healthy side.

xi.

Spinal accessory:
Trapezius elevation of shoulder against resistance.
Sternomastoid turn his head against resistance.

xii.

Hypoglossal:
Ask the patient to stick out his tongue tongue is deviated to the weak
side.