tag:blogger.com,1999:blog-37614292618884318202024-03-14T14:11:39.794+08:00Memory Aids for MedicineMnemonics, Diagrams and Other Memory Aids for Learning MedicineYoke-Yeow Yaphttp://www.blogger.com/profile/05894275779933392361noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-3761429261888431820.post-11186838385068439792009-02-07T10:28:00.005+08:002009-02-07T15:07:30.387+08:0010 Functions of Skin<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://brainyjane22.files.wordpress.com/2008/03/crazy-child.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 219px; height: 300px;" src="http://brainyjane22.files.wordpress.com/2008/03/crazy-child.jpg" border="0" alt="" /></a><br />The 10 functions of skin are:<br />Protection - physical, chemical, immunological, antimicrobial<br />Appearance<br />Cushion<br />Homeostasis<br />Thermoregulation<br />Manipulation - nails<br />Sensation<br />Nutritional - vitamin D synthesis<br />Hormonal - testosterone synthesis<br />Pheromonal<br /><br /><br />Mnemonic: <span style="font-weight:bold;">P</span>sycho <span style="font-weight:bold;">A</span>DHD <span style="font-weight:bold;">C</span>hildren <span style="font-weight:bold;">H</span>ave <span style="font-weight:bold;">T</span>errible <span style="font-weight:bold;">M</span>ood <span style="font-weight:bold;">S</span>wings '<span style="font-weight:bold;">N</span>' <span style="font-weight:bold;">H</span>arass <span style="font-weight:bold;">P</span>arents<br /><br /><span style="font-style:italic;">Source: Davidson's Principles and Practice of Medicine, 20th ed.</span>Yoke-Yeow Yaphttp://www.blogger.com/profile/05894275779933392361noreply@blogger.com1tag:blogger.com,1999:blog-3761429261888431820.post-82623953079349676022009-02-07T08:55:00.008+08:002009-02-07T10:54:10.265+08:00The 1-to-6 of Skin Structure<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_bAPC3aXU3v0/SYzxE4lXyHI/AAAAAAAAD7o/IBnodfJoi6U/s1600-h/skin.jpg"><img style="display:block; margin:0px auto 10px; text-align:left;cursor:pointer; cursor:hand;width: 400px; height: 300px;" src="http://1.bp.blogspot.com/_bAPC3aXU3v0/SYzxE4lXyHI/AAAAAAAAD7o/IBnodfJoi6U/s400/skin.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5299875927719135346" /></a><br /><br />Skin & and its appendages have/are<br />- 1 organ<br />- 2m-sq in area, 2 structures in subcutis (dermal papilla, subcutaneous vessel)<br />- 3 layers (epidermis, dermis, subcutis)<br />- 4kg in weight, 4 layers in epidermis<br />- 5 layers in basement membrane (basal keratinocyte, basal cell membrane, lamina lucida, lamina densa, sub-lamina densa)<br />- 6 structures in dermis (sweat gland, sweat duct, sebaceous gland, hair, superficial vascular plexus, deep vascular plexus)<br /><br /><span style="font-style:italic;">Source: Davidson's Principles and Practice of Medicine, 20th ed.</span>Yoke-Yeow Yaphttp://www.blogger.com/profile/05894275779933392361noreply@blogger.com1tag:blogger.com,1999:blog-3761429261888431820.post-24036169845628587122009-01-16T13:50:00.001+08:002009-01-16T13:53:46.838+08:00Technique: Using the 2x2One mental tool I've found very useful is the 2x2 table (or 3x3, or 4x4, for that matter) to work out possible permutations and combinations of clinical signs and symptoms. I remember one from my undergraduate surgery days in approaching RHC pain for instance: <br /><br />RHC pain is of hepatobiliary or pulmonary origin. And the hepatobiliary causes come either with or without jaundice, or with or without fever. So given these two dichotomous parameters - we have a 2x2 - and its quadrantic (4) subgroups of differentials.<br /><br /> Fever No Fever<br />Jaundice (1)Cholangitis (2)Choledocholithiasis<br /> CholangioCA, CA head of pancreas<br />No Jaundice (3)Cholecystitis (4)Biliary stasis<br /> Empyema Mucocele<br /><br />We can add on more variables as we go along, like palpable lump or no palpable lump. Which should make 2x2x2 = 8 sub-groups. Where L=lump, NL=No lump, we now have:<br /><br /> Fever No Fever<br />Jandice (1a)NL: Cholangitis (2a)NL: Choledocholithiasis<br /> (1b)L: ? (2b)L: CholangioCA, CA head of pancreas<br />No Jaundice (3a)NL: Cholecystitis (4a)NL: Biliary stasis<br /> (3b)L: Empyema (4b)L: Mucocele<br /><br />Looking at the above, there is yet no obvious answer for combination 1b - fever+jaundice+lump. Unless, of course, when we factor in the confounding 'dual-pathology'. In that case we can have four possible combinations that result in fever, jaundice and a lump:<br /> 1a + 4b (cholangitis with a mucocele), <br /> 2a + 3b (choledocholithiatis with an empyema), <br /> 2b + 3a (CA + cholecystitis), <br /> 1a + 2b (cholangitis with CA). <br /><br />Confusing? Let's not even get into triple pathology!<br /><br />One can do this for everything in medicine; for instance in lung examination , taking into consideration dull/resonant percussion, increased/reduced fremitus, tracheal deviation away/towards lesion, increased/reduced breath sounds, and presence/absence of crepitations. That gives us 2x2x2x2x2 = 32 possible permutations.<br /><br />In ENT, an easy one is the Rinne and Weber's test. Rinne +ve/-ve, Weber towards/away from the bad ear gives us a nice 2x2 for unilateral ear pathology. Drawing a two by two for the BAD EAR, we get:<br /><br /> Rinne+ Rinne-<br />Weber towards mild CHL (<10-15dB) CHL (>10-15dB)<br />Weber away SNHL profound SNHL {the false -ve}<br /><br />I find working out these permutations very useful to preempt a jaw-drop during an exam (what the heck does this combination suggest?!) and also to think of all the possible presentations of disease.Yoke-Yeow Yaphttp://www.blogger.com/profile/05894275779933392361noreply@blogger.com0tag:blogger.com,1999:blog-3761429261888431820.post-74203271919769083582008-12-22T20:11:00.003+08:002008-12-22T20:37:24.199+08:00Rye classification for Hodgkin's lymphoma<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://www.lmp.ualberta.ca/resources/pathoimages/Images-R/000p0112.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="http://www.lmp.ualberta.ca/resources/pathoimages/Images-R/000p0112.jpg" border="0" alt="" /></a>The Rye classification for Hodgkin's lymphoma, in order of frequency<br />• <span style="font-weight:bold;">N</span>odular <span style="font-weight:bold;">S</span>clerosis<br />• <span style="font-weight:bold;">M</span>ixed cellularity<br />• lymphocyte <span style="font-weight:bold;">D</span>epleted<br />• lymphocyte <span style="font-weight:bold;">P</span>redominant<br /><br />Lymphocyte-predominant has the best prognosis while lymphocyte-depleted has the worst.<br /><br />A comparison can be found in <a href="http://books.google.com/books?id=H85dwxYTKLwC&pg=PA841&lpg=PA841&dq=rye+classification+for+hodgkins+lymphoma&source=web&ots=A9ohIRxjET&sig=dxZo7DluseY04VkpxB0RRaEJYKo#PPA843,M1">Blood: Principles and Practice of Hematology</a> online<br /><br /><span style="font-style:italic;"><span style="font-weight:bold;">N</span>aked <span style="font-weight:bold;">S</span>piders <span style="font-weight:bold;">M</span>ake<span style="font-weight:bold;"> D</span>ogs <span style="font-weight:bold;">P</span>uke... don't ask me why!</span>Yoke-Yeow Yaphttp://www.blogger.com/profile/05894275779933392361noreply@blogger.com0tag:blogger.com,1999:blog-3761429261888431820.post-73959344171697438192008-12-22T19:56:00.002+08:002008-12-22T20:08:23.839+08:00Drug-induced cholestasis<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_M6KdZzUIyxE/Rq6yXPp4UDI/AAAAAAAAA0Y/cftKea2_XpI/s400/Frui_Combo_Sago_Teh_Si.JPG"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 300px; height: 400px;" src="http://1.bp.blogspot.com/_M6KdZzUIyxE/Rq6yXPp4UDI/AAAAAAAAA0Y/cftKea2_XpI/s400/Frui_Combo_Sago_Teh_Si.JPG" border="0" alt="" /></a>Drugs that can cause cholestatic jaundice:<br />• <span style="font-weight:bold;">C</span>hlorpromazine<br />• <span style="font-weight:bold;">A</span>ntibiotics (flucloxacillin, fusidic acid, co-amoxiclav, nitrofurantoin)<br />• <span style="font-weight:bold;">P</span>rochlorperazine<br />• <span style="font-weight:bold;">S</span>ulfonylureas<br />• <span style="font-weight:bold;">A</span>nabolic steroids<br />• <span style="font-weight:bold;">G</span>old<br />• <span style="font-weight:bold;">O</span>ral contraceptives<br /><br /><span style="font-style:italic;">If you're gonna get jaundice, get it from eating <span style="font-weight:bold;">CAP SAGO</span>!</span><br /><br />Source: Oxford Handbook of Clinical Medicine<br /><br />Learning prompted by one of my patients developing jaundice post-op. LFT showed cholestatic picture too! Remitted spontaneously after stopping IV Augmentin (after checking OHCM!).Yoke-Yeow Yaphttp://www.blogger.com/profile/05894275779933392361noreply@blogger.com2tag:blogger.com,1999:blog-3761429261888431820.post-38342534909105753602008-12-22T17:03:00.002+08:002008-12-22T20:10:40.270+08:00Antibiotic-induced fever<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://i.ehow.com/images/GlobalPhoto/Articles/2132114/porcupine-main_Full.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 600px; height: 450px;" src="http://i.ehow.com/images/GlobalPhoto/Articles/2132114/porcupine-main_Full.jpg" border="0" alt="" /></a><br /><br />Six antibiotics known to cause fever are:<br /> <span style="font-weight:bold;">⟐ Procainamide<br /> ⟐ Quinidine<br /> ⟐ Penicillin<br /> ⟐ Isoniazid<br /> ⟐ Nitrofurantoin<br /> ⟐ Erythromycin</span><br /><br /><span style="font-style:italic;">Antibiotic-induced fevers are a thorny issue, together they spell <span style="font-weight:bold;">PorQPINE</span>!</span><br /><br />Source: <a href="http://www.fpnotebook.com/ID/Pharm/DrgIndcdFvr.htm">Family Practice Notebook.com</a>Yoke-Yeow Yaphttp://www.blogger.com/profile/05894275779933392361noreply@blogger.com0