Intussusception trivia

Some mnemonics are useful and others are just plain trivia. Here is some intussusception trivia that is easy to remember:

  • In adults, a cause may be found in 2/3 of cases
  • 2/3 of known causes will be due to neoplasm
  • 2/3 of these neoplasms are malignant

This is why some may prefer to resect an intussusception in an adult (as opposed to reduce it as is done in children).

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Source: This bit of trivia was found in Skandalakis’ Surgical Anatomy.

Thanks for subscribing or visiting! Wishing you all an enjoyable summer!

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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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Triads, pentads and classic presentations (part 10)

So the “Triads, pentands and classic presentations” series has reached its 10th post! Just when you thought all the good ones were already posted here, here is another one!

Borchadt’s triad for gastric volvulus:

1) severe epigastric pain

2) retching without vomiting

3) inability to pass a nasogastric tube

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Have a great week! Good luck to those writing their pre-holiday university exams.

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Triads, pentads and classic presentations (part 6)

This week, The Weekly Menmonic presents triads galore.

Mackler’s triad for Boerhaave syndrome (rupture of the esophageal wall):

(1) Lower chest pain, (2) Subcutaneous emphysema, (3) Emesis

Classic triad of ruptured abdominal aortic aneurysm:

(1) Abdominal pain, (2) Pulsatile abdominal mass, (3) Hypotension

Classic triad for acute mesenteric ischemia:

(1) Acute onset of abdominal pain which is classically out of proportion to the physical exam, (2) Vomiting and/or diarrhea, (3)  History of atrial fibrillation or heart disease

 

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Happy studying….

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Triads, pentads and classic presentations (part 4)

As promised, here is part 4 of the “triads, pentads and classic presentations” series. The WM always welcomes any contributions for future editions!

  • Triad of Henoch-Schonlein Purpura: (1) Abdominal Pain, (2) Purpura, (3) Arthritis
  • Three specific signs of Graves disease: (1) Exophthalmos, (2) Pretibial myxedema, (3) Thyroid bruit
  • Cushing’s triad for elevated intracranial pressure: (1) Bradycardia, (2) Bradypnea, (3) Hypertension

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Have a great week!! Thank you all for reading.

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Triads, pentads and classic presentations (part 2)

Medicine loves its triads, pentads and classic presentations. Here is the second of a series of posts that will allow you to find them in one place for easy studying. (Click here for the part 1)

  • Horner’s syndrome (think “PAM” Horner): (1) ptosis, (2) anhydrosis, (3) miosis.
  • Renal cell carcinoma triad:  (1) hematuria, (2) flank pain, (3) abdominal mass
      • Note this triad only appears 10% of the time
  • Charcot’s triad for ascending cholangitis: (1) fever (2) RUQ pain (3) Jaundice
  • Reynaud’s pentad for ascending cholangitis: Charcot’s triad + hypotension and mental status changes

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Thanks for reading! 3x

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Diseases of the (para)thyroid glands

I recently found a nice letter-to-the-editor entitled “Mnemonics for endocrinologists: hyperparathyroidism” written by Janusz Myśliwiec in a Polish endocrinology journal which provided 3 mnemonics for hyperparathyroidism. The first mnemonic is for remembering the etiology of hypercalcemia: RHINOS.

R = Renal insufficiency (i.e. secondary and tertiary hyperparathyroidism)
H = Hyperparathyroidism (i.e. primary hyperparthyroidism)
I = Immobilisation and iatrogenic (overdose of calcium/vitamin D, thiazides)
N = Neoplasms (bone mets, bone cancers, paraneoplastic)
O = Other endocrinopathies (thyrotoxicosis, Addison’s disease)
S = Sarcoidosis

The second mnemonic describes the clinical presentation of hyperparathyroidism (which is essentially the presentation of hypercalcemia): “Stones, bones, abdominal groans and psychiatric overtones”

Stones = Kidney stones/nephrocalcinosis/renal failure and biliary stones
Bones = Bone pain (osteitis fibrosa cystica, osteoporosis, osteomalacia)
Abdominal groans = GI symptoms of nausea, vomiting, constipation
Psychiatric overtones = Psychosis, anxiety, lethargy, memory loss, depression, coma

The third mnemonic is a more extensive description of the same clinical picture: “PARAT-HORMONE”

P = Poor bones
A = Abdominal pain
R = Renal stones (nephrocalcinosis and renal failure)
A = Altered mental state
T = Thirst (i.e. polydipsia due to polyuria)

H = Hypertension (50% of patients)
O = Ocular calcifications (and other tissue calcifications)
R = von Recklinghausen’s osteitis fibrosa cystica
M = Muscle weakness
O = Other MEN1 and MEN2a components
N = Non-normal lab values (high calcium/parathormone/alkali phosphatase and low phosphate)
E = Electrocardiogram (shortened QT and bradycardia, increased sensitivity to digitalis and risk of asystole)

Last but not least, thanks to Leah for submitting the following mnemonic for “hyperTHYROIDISM”

T = Tremor
H = Heart rate (increased)
Y = Yawning (fatigue)
R = Restlessness
O = Oligomenorrhea/amenorrhea
I = Irritability
D = Diarrhea
I = Intolerance to heat
S = Sweating
M = Muscle wasting/weight loss

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Thanks for reading! Happy studying!

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