The Surgical Sieve

The consultant surgeon turns to you and barks "What are the causes of ____ " - all eyes are now on you to remember your surgical sieve and come up with the common as well as the wierd and wonderful. But wait, what was the mneumonic again?... On old mount olympus... no wrong one.... in a surgeons gown most... no don't think it was that one... was it something about vitamins?

Here's a little mneumonic which actually has something to do with surgical seive-ing. Just think of a sieve made of tin - a Tin Civ:

So that gets the most common causes to the top of your mind (trauma, infection, neoplasm), instead of coming up with a congenital disorder as your first answer.

Sulfonamides

More additions to the antibiotic range....

Sulfonamides (f vs. ph?? - it's an f in the BNF) are:
    TRI methoprim
    Co TRI moxazole

So think of someone from the network 3 (TRI) trying to sell you a phone: "sell-phone...amide.....sulfonamide".

The other antibiotics are available here.

Monoclonal Tumour Markers

• CA 125 = Ovarian Cancer
• CA 19-9 = Pancreatic Cancer
• CA 15-3 = Breast Cancer

 *these are usual associations, it is possible that each of these are raised in other cancers (CA125 also found in pancreatic, gastric, colonic, breast)

Alternative Bristol Stool Chart

Can't take the credit for this one (was one of my lecturer's) - it's a pretty good way of taking a bowel habit history:

B-cell lymphoma genetic links

Genetics of lymphomas - translocations cause overexpression of the following genes which cause the disease:

• myc - Burkitts + B & T-cell lymphomas
• bcl2 = follicular B-cell lymphoma
• bcl3 = chronic B-cell lymphoma
• bcl6 = diffuse  B-cell lymphoma
• any other genes = acute T-cell lymphoma

So you can use this mirror image to remember the bcl genes:

Kartagener's Syndrome

Here's another eponymous syndrome named Kartagener's (German physician, 1933)*. It's a triad of features:

• Dextrocardia or Situs inversus
• Brochiectasis
• Recurrant sinusitis

It's more scientifically known as primary ciliary dyskinesia - meaning cilia in the body don't beat properly. This is a problem during development where you need correctly beating cilia to put your organs in the right place (the cilia cause little waves of growth factor to swoosh around). If they beat the wrong way you get situs inversus or dextrocardia. If they don't beat at all it's situs ambiguus and organs end up in random places.

Here's my random picture for remembering this syndrome:

 

This heart (dextrocardia) in a cart (Kartageners) was traveling past a wrong way sign (..a..situs...sinusitis) and crashed into a tree (broken tree = broken bronchial tree = bronchiectasis).

* Kartagener M (1933). "Zur Pathogenese der Bronchiektasien: Bronchiektasien bei Situs viscerum inversus". Beiträge zur Klinik der Tuberkulose. 83 (4): 489–501.
* also... Situs Solitus is the normal positioning of organs in the body.

Cerebral Toxoplasmosis

Disease of the immunocompromised. Acute onset focal neurological deficit, usually hemispherical (hemiparesis, visual field disturbance). Can be accompanied by fever. Imaging shows characteristic ring-enhancing lesions:

Guillain-Barre Syndrome

Another eponymous syndrome named by a French physician at the turn of the century.

• It is an acute, inflammatory, post-infectious, ascending polyneuropathy (2:100,000).
• Caused by (??): post viral (often: Campylobacter jejuni or CMV) cell mediated response against peripheral gangliosides. 
• Polyneuropathy begins peripherally and progresses centrally - if it reaches respiratory/bulbar areas this is bad.
• Often causes autonomic dysfunction (sweating, tachycardia, dysrhthmias)
• CSF shows lots of protein  (>5.5g/L)
• Develops over around 4 weeks.
• Most important investigation: spirometry

So to remember these random facts I think of this knight character: Sir Guillain-Barre...

 * boot camp - to reflect that neuropathy often begins in feet (boot) and most commonly caused by CAMPylobacter Jejuni.
** also note pronounciation - gwee-awn barr-ay (in your best french accent)

Pleural Effusions

Pleural effusions can be exudative (>30g/L protein) or transudative (<30g/L protein). Things that commonly cause effusions of each type are:

Also light's criteria - if any of the following are true then = exudative:

• Pleural/Serum protein ratio > 0.5
• Pleural/Serum LDH ratio > 0.5
• Pleural fluid LDH > 2/3 of serum LDH level.

Na+ and K+ in Addisons and Cushings

On the ward the other day 3 of us got very confused by the changes in K+ and Na+ in addisions, Cushings and Conns. We worked back to first principles and figured it out in the end, but to save time I thought of this blatant generalisation:

Addisions can kill you, Cushings and Conns can't.

Helps me to remember that K+ is high in addisions but low in Cushings and Conns (follows that Na+ is the opposite).

* disclaimer: I'm sure cushings and conns could kill you, and addisons might not. Anyway the point is how to remember the changes in K+ !

ECG Update

A while back I posted this about ECG's. Here's an update for those who found it useful - now including which coronary artery each lead relates to:

• Coffee Cup with circle around it = Latte = Lateral leads (supplied by CIRCumflex)
• Info sign = InfeRior, supplied by right coronary (infoRmation)
• Ant with football = Anterior leads, the ant is a bit of a "lad" (left anterior descending)
• Septal leads = equally supplied by RCA and LAD depending on anatomical variance.

Route planner

Here's a useful resource for anoyone on central london firms at Barts....

Weber's and Rinne's test

This one is pretty well known but thought I'd add it anyway.

Weber's test -
tuning fork on forehead.
Loud on one side:
= conductive loss on same side
or
= sensorineural loss on opposite side

Rinne's test -
tuning fork next to ear and on mastoid process.
Normal = Air louder than bone (+ve rinne's)
Conduction loss = Bone louder than air (-ve rinne's)
Sensorineural = Both the same

Next time you see someone actually doing this test, please take a photo and sent it to me!

Anterior Pituatary Hormones

These are the anterior pituatary hormones.

Think of an ant (Anterior) swimming around in a bowl of milk (Prolactin) with some alphabet cereal (All the hormones which are abbreviated).

Posterior pituatary does everything else (Oxytocin + Vasopressin).

Grouch-er's

Gaucher's Disease

This is a lysosomal storage disease caused by hereditory deficiency of glucocerebrosidase. Characterised by hepatomegally and splenomegally due to lipid not being broken down by glucocerebrosidase.

So...here is oscar the grouch (Gaucher's) in his dustbin (distended abdomen from splenomegally & hepatomegally) drinking Cerebro-cider (gluco-cerebro-sidase) which causes neurological complications.