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...

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