How severe is your Ulcerative Colitis?

The Truelove Criteria (awesome name BTW...) grades the severity of Ulcerative Colitis based on 5 parameters:

UC Severity - She Hasn't Even Finished Pooping!

Stool frequency per day (has to be bloody stool)

Haemoglobin

ESR

Fever

Pulse rate

	MILD	MODERATE	SEVERE
Stool frequency /day (bloody stools)	<4	Moderate severity are values that are in between MILD & SEVERE	>6
Haemoglobin	>11.0		<10.5
ESR	<30		>30
Fever	Afebrile		>37.8
Pulse rate	<70		>90

 

Myasthenia Gravis associations

Diseases associated with Myasthenia Gravis - STRAPD (read: 'strapped')

S - SLE or Sarcoid

T - Thymoma or Thyroid disease (hypo/hyper)

RA - Rheumatoid Arthritis

P - Pernicious Anaemia

D - the 2 DMs : diabetes mellitus & dermatomyositis

PGA - more Addison's than Tiger Woods....

Some quick notes about the group of diseases known as Polyglandular Autoimmune Syndrome (PGA).

• 2 types exist - PGA I and PGA II (PGA II is the MORE COMMON of the two)

• Each is a constellation of THREE diseases - but the diagnosis can be clinched by just having only 2 out of 3.

• The common link between the two is autoimmune Addison's disease

PGA I:

Parathyroid - autoimmune HYPOparathyroidism

Gandida (boo hoo....this represents a new low in mnemonic making) - chronic mucocutaneous candidiasis

Addison's disease

Chronologically, chronic mucocutaneous candidiasis appears first, followed by hypoparathyroidism, and lastly Addison's.

PGA II - also with Addison's and 1 of the 2:

1) Type 1 DM (contrast this with candidiasis, which is common in Diabetics)

2) autoimmune THYROID disease - more commonly Hashimoto's than Graves' (contrast this with Parathyroid involvement of PGA I)

Parathyroidectomy - to chop or not to chop?

The following are definite indications for SURGICAL management of HYPERPARATHYROIDISM  (based on American National Institutes of Health consensus)

Indications for Parathyroidectomy - Calcium BuRNS !!!

Calcium - either SERUM > 3.0 or URINARY Ca2+ markedly elevated

BMD decreased

u (null)

Renal impairment

Nephrocalcinosis &/or Nephrolithiasis

Symptomatic hypercalcemia that is severe

Conservatively managed HyperPTH patients require YEARLY:

1) serum calcium 

2) U+Es

3) Renal USS

4) BP

5) & a BMD every 2-3 years.

I've got some NERVE plagiarising these mnemonics

Ha Ha. Corny.

Here are two commonly seen/available mnemonics regarding neuritides:

Causes of Carpal Tunnel Syndrome - MEDIAN TRAP

Myxoedema (ie. Hypothyroidism)

EtOH

Diabetes Mellitus

Idiopathic

Amyloidosis

Neoplasia

Trauma

Rheumatoid Arthritis

Acromegaly

Pregnancy 

Causes of Mononeuritis Multiplex - WARDS PLC (Courtesy of the good ol' Cheese & Onion)

Wegener's Granulomatosis

Amyloidosis

Rheumatoid Arthritis

Diabetes Mellitus

Sarcoidosis/SLE

Polyarteritis Nodosa

Leprosy

Carcinomatosis

**rule of thumb: think infiltrative diseases (ie. Sarcoid/Amyloid) and Vasculitis/CTDs (SLE, RA, WG, PAN)

Nephrotic VS Nephritic - where one letter makes a world of a difference

Back when I was a medical student, I thought my nephrology lecturer was a fickle dyslexic - which explained why he kept flitting between nephritic and nephrotic in his lecture notes.  And I wonder why I never really grasped either syndrome until now... ...

Features of nephrotic syndrome - "NAPHROTIC"

Na+  - you may rarely get hyponatremia in nephrotic syndrome; this is also a reminder that there is an intense pathophysiologic retention of sodium due to reduced oncotic pressure

Albumin - serum levels are decreased

Proteinuria >3g/day

Hyperlipidemia

Renal vein thrombosis

Oedema

Thrombosis

Infections - more prone to them due to loss of Ig in the urine

Coaguability

Features of nephritic syndrome - "HO HO"

Hematuria - not forgetting the all-important RED CELL CASTS

Oedema

Hypertension

Oliguria (secondary to developing azotemia) 

Admittedly, the 2nd mnemonic is pretty weak =P

I guess the take home point is to be aware of the complications that can arise in patients with nephrotic-range proteinuria.  On the other hand, one needs to be very wary of deteriorating renal function in patients who develop red-cell casts.

Erythema Nodosum VS Pyoderma Gangrenosum

Causes of Erythema Nodosum - DISSTend

Drugs (OCP, Penicillin, Sulfonamides)
IBD
Streptococcal infections
Sarcoid
TB
end - just a reminder that this the mnemonic for erythema nodosum


Causes of Pyoderma Gangrenosum - I Hate RPGs (I really do BTW...)
IBD
Hepatitis / Hematologic malignancies
RA
PG - reminder that it's Pyoderma Gangrenosum we're talking about here...