Jones' Criteria for Rheumatic Fever - Jones' Fear No-one

Jones' Criteria for Rheumatic Fever - JONES FEAR NO-1

In addition to evidence of recent Streptococcal infection (eg ASOT, positive throat swab c/s), we need either 2 major OR 1 major + 2 minor criteria

Major Criteria:

Joints - migratory, flitting polyarthritis

 - Carditis

Nodules (subcutaneous)

Erythema marginatum

Sydenham's chorea

Minor Criteria:

Fever

ESR raised

Arthralgia

Rheumatic fever previously

No-1 = First degree H/B on ECG

CHOLESTATIC drugs

Drugs causing cholestasis - CHOLESTATIC

CHlorpromazine

Ofloxacin

Largactil (ie chlorpromazine...cldn't think of any L-drugs)

Erythromycin

Sulfamethoxazole

+

Trimethoprim (Co-Trimox)

Augmentin (ie Co-Amoxiclav)

Tetracycline

Ibuprofen

Cimetidine

Mnemonics on poisoning

Indications for Hyperbaric O2 therapy in CO poisoning - NEPAL 40

Neurological toxicity (the most indicative being cerebellar symptoms)
ECG changes (the need for DCCV or Defib is a relative C/I to hyperbaric O2)
PregnAncy
Loss of consciousness
>40% CO-Hb


Symptoms of Lead Toxicity - LEAD (kudos to Esben Vogelius)

Lines across gums (Burton's Lines - poor dentition is usually a prerequisite for this sign, so rarer in children)
Erythrocyte stippling (also Sideroblastic anemia)
Abdominal pain
Drop, foot or wrist (Lead neuropathy is largely motor)
also, don't forget to look for neurodevelopmental symptoms

Graft versus Host Disease - Symptomology

acute GvHD occurs within 100 days of transplanting (immuno-competent) donor cells into an immuno-deficient host.

the classic triad of symptoms correspond to the abbreviation for this syndrome (ie. GvHD)

Gastroenteritis - diarrhoea
Hepatitis - biochemically evident, with or without jaundice
Dermatitis - ranges from mac-pap rash (that can be painful/pruritic) to exfoliative erythroderma

Bony Metastasis

Common Tumours Metastasising to bone - L.P. Thomas Kisses Best (or Breast)

Lung
Prostate
Thyroid
Kidney
Breast


Common sites of skeletal metastases - CASPERSKY (in order of frequency)

CA - reminder that bony malignancies are usually secondary
Spine
PElvis
Ribs
SKull
Y - looks a lil' like your femur 'eh? (ie Proximal Long Bones... ...rubbish I know =P)

HUS/TTP - CRAFTY syndromes

Symptoms of HUS/TTP - CRAFTY (thank you ValueMD)

CNS symptoms -> visual symptoms, paresis, fits, changing conscious levels
Renal failure
Anemia -> Microangiopathic Haemolytic Anaemia (MAHA)
Fever
Thrombocytopenia
Y does it occur?
In HUS/TTP there are autoantibodies against the ADAM-TS13 metalloproteinase. ADAM-TS13 prevents the polymerisation of vWF -> hence when it is inhibited, vWF polymerises into larger, more active molecules - causing more platelets to clump to it and resulting in a fall in circulating platelet counts and intravascular microthrombi.

Causes include: E coli 0157, Shigella, Adenovirus, Pneumococcus, OCP, Pregnancy, SLE, HIV [haven't got a mnemonic for this list yet =( ]

Deadly Headaches - THIS GEM

Deadly headaches that should be excluded - THIS GEM

Temporal arteritis
Hypertensive headaches
ICP increased
Sub-arachnoid haemorrhage

Glaucoma
Encephalitis
Meningitis

Psychiatry at a glance - Suicide Risk, NMS, 5-HT Syndrome, Depression

Assesing suicide risk/severity - MAN THIS ISN'T FAIR (Credit: Dr A Sankaranarayanan)

Mental status (eg. depressed, anxious, agitated, guilt/shame, delusions)
Attempts (prev suicide attempts + exploring the lethality if any)
Nothing to live for (e.g. no family support, career, sense of hopelessness)

Trigger (any precipitants for the suicide attempt?)
Help - did patient seek help after the attempt
I=IDEAS and INTENTION (ie. explore suicide plans & confidence level to see it thru)
Substance abuse

Ilness (Medical or Psychiatric)
Suicide in the family
N’T = suicide NOTE (also telling others prior to attempt)

Final arrangements (eg. final goodbyes, leaving a will)
Access to suicide means (e.g., firearms)
Isolation (ie. made efforts to be undiscovered?)
Regret surviving the suicide attempt??


Symptoms of Neuroleptic Malignant Syndrome - FALTER

Fever / Fluctuating consciousness
Autonomic instability
Leucocytosis
Tremor
Elevated CK
Rigidity


Symptoms of Serotonin Syndrome - FiRe My CoFe
(again, a poor mnemonic that has absolutely no link to the clinical condition =P)

Fits
Reflexes increased

Myoclonus

Confusion
Fever


Assessment of Depression - ME ESCAPINGS

Mood (depressed)
Enjoyment (ie. anhedonia)

Energy
Sleep (insomnia or hypersomnia)
Concentration (diminished concentration or indecisiveness)
Appetite (decreased OR increased)
Psychomotor retardation (OR agitation)
IN Guilt (excessive/inappropriate feelings of guilt or worthlessness)
Suicide (recurrent suicidal ideation/attempt)

MDD = >4 symptoms daily for 2/52, one of which has to be part of "ME" (Mood OR Enjoyment)

Severity of PVCs

Excuse my language....sorry!

Severity of PVCs - My Cock F*cks Real Pussy

Multiform (ie PVCs of >1 morphology) -> Lown Grade 3
Consecutive (ie 2 or more PVCs occuring in a row) -> Lown Grade 4
Frequent (defined as >30 PVCs/hr) -> Lown Grade 2
R-on-T phenomenon -> Lown Grade 5
Post-MI (PVCs occuring after the onset of an MI should be regarded with caution)

Symptoms of Asthmatic Emergencies

Severe Asthma - TRIP

Tachycardia >110bpm
RR > 25/min
Inability to speak full sentences
PEFR 33-50% of expected


Life-threatening Asthma - SHOCKED

Silent chest
Hypotension
O2 <>
Cyanosis
Konfusion
Exhaustion (ie. feeble respiratory effort)
Dysrhythmmias

also, PEFR <33% of expected (if patient is even capable of performing PEFR)