The F word

As the title of the post suggests, this week’s post will take a turn towards the arguably-not-so-PC. If you don’t like one of the F words of this week’s mnemonic, I provide a more PC alternative. :)

When suspecting obstructive biliary disease, think of the 5 factors that describe the patient population frequently affected by gallbladder disease. These 5 factors are remembered with the “5 ‘F’s”

Fair

Female

Forty

Fertile

Fat (or use the more polite term “full”)

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Congratulations to the Canadian 4th year medical students on the residency Match!! Good luck to the Americans!

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Scoring and risk stratification (part 5)

The Alvarado score is a popular score used in emergency medicine to determine the likelihood of an appendicitis. This score is a high sensitivity for appenciditis and is therefore best for ruling it out (sensitivity of a score of 5 is 99% and specificity of a score of 7 is 81%). It is unreliable in children and more reliable in men than women. You may refer to a systematic of the Alvarado score below.

The Alvarado score has 8 criteria for a total score of 10 points. Alvarado score may be remembered using the following memory trick: “My Appendix Feels Likely To Rupture Now”.

My = Migration of pain to the right iliac fossa

Appendix = Anorexia

Feels = Fever of 37.3 Celsius or more

L = Leukocytosis

T = Tenderness in the right iliac fossa

R = Rebound tenderness

N = 1) Nausea or vomiting 2) Neutrophilia

**Tenderness in the right lower quadrant and leukocytosis count for 2 points each. All other criteria count for 1 point.

A score of 1 to 4 points has a 30% probability of being appendicitis. No imaging is suggested (note: if score is 4 points and there is clinical suspicion, imaging is suggested). The patient may be discharged.

A score of 5 to 6 points has a 66% probability of being appendicitis. A CT of the abdomen is suggested. The patient should be observed +/- admitted.

A score of 7 to 10 points has a 93% probability of being appendicitis. Consult a surgeon.


Please refer to this article by Ohle et al. entitled “The Alvarado score for predicting acute appendicitis: a systematic review” for more reading. Thanks for reading!

*Note: this tool (and other risk stratification tools posted on this blog) is only for use by medical professionals in the medical context. If you are concerned for your health, please consult your physician!

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Your submissions

Thanks to those who submitted suggestions to TheWeeklyMnemonic in the past month.

One reader suggested the “AMERICA” mnemonic for the TIMI risk score which was previously posted here. It is always nice to review things that we have forgotten!

Rebecca shared an equally practical mnemonic for the management of opioid prescriptions for chronic pain. She obtained this from her palliative care course. The mnemonic in question is the “5A Opioid monitoring tool“, which is summarized below. You may refer to this link for a PDF which goes into more detail on how to use one version of the 5As.

• Analgesia (i.e. degree of pain relief provided by the opioids)

• Activities of daily living (i.e. the patient’s physical and psychosocial function)

• Adverse effects and remedies for these (i.e. constipation, nausea, etc.)

• Aberrant drug-taking behaviour (i.e. abuse/misuse)

• Accurate medication record

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Thanks for the contributions. Keep them coming! Have a great week.

The Weekly Mnemonic has more than 10, 000 views! To celebrate, in December, The WM will change its look and will offer a Christmas prize to one of its followers! Have a wonderful week.

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The “WILD” side– History taking for substance abuse

This week we have a set of memory aids that you may use when assessing your patient for substance use.

1)  Is your patient running “WILD”? If they have impairment or distress secondary to substance usage for >12 months and at least 1 of the WILD criteria, they have a substance abuse problem:

W = Intereferes with obligations at Work, school or at home.
I = Continued usage despite Interpersonal or social consequences
L = Legal problems related to substance usage
D = Usage in Dangerous situations

2) The CAGE questionnaire is a commonly-used screening tool for alcoholism. Each letter of the acronym is a question in the questionnaire. If the patient answers “yes” to 2 or more of the CAGE questions, the possibility of alcoholism should be explored.

C = Have you ever felt that you need to Cut down on your drinking?
A = Have you ever been Annoyed when others criticized your drinking?
G = Have you ever felt bad or Guilty for drinking?
E = Have you ever had a drink first thing in the morning (i.e. as an Eye-opener) to calm your nerves or rid yourself of a hangover? 

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Thanks for reading! Have a great week!

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Let’s take a history!

To remember important elements of the past medical history, remember this phrase: “CHAMPS DO HAM”

C: Cancer
H: Hypertension
A: Angina
M: Myocardial infarction
P: PE/DVT
S: Stroke

D: Diabetes
O: Obs/Gyn (includes GPA, menstrual history, sexual history….Obviously, for males, just ask for sexual history)

H: Hospitalizations (medical/surgical)
A: Allergies
M: Medications

To ensure that you don’t forget any constitutional symptoms, think of the patient as being: “Hot, tired, and not hungry.”

Hot: Fever/chills, sweats
Tired: Fatigue, change in sleep habits
Not hungry: Appetite, weight loss

There are several good mnemonics for taking a pain history, many are variations of “OPQRST”:

O: Onset
P: Provocation and palliation
Q: Quality (Is it sharp, dull, ripping, crushing, squeezing, burning, freezing? Is it throbbing, constant, intermittent?)
R: Region and radiation
S: Severity
T: Time (i.e. chronology: how long it has been going on, has it improved or worsened)

Personally, I find the “CLOSER” pain assessment tool more useful:

C: Characteristics (quality and severity)
L: Location and radiation
O: Onset and duration
S: Symptoms associated
E: Exacerbating factors
R: Relieving factors

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That’s it for this week! Thanks for reading!

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