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USMLE
Lana
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Lana
EMERGING AND RE-EMERGING INFECTIOUS DISEASES
~8.4 mins read
INTRODUCTION
An infectious disease is a disease that is caused by the invasion of a host by agents whose activities harm the host's tissues and can be transmitted to other individuals.
Infectious disease have for centuries ranked with wars and famine as major challenges to human progress and survival. They remain among the leading cause of death and disability worldwide. Against a constant background of established infections, epidemics of new and old infectious diseases periodically emerge, greatly magnifying the global burden of infections. Study of these infections reveal the evolutionary properties of pathogenic microorganisms and the dynamic relationships between microorganisms, their host and the environment.
Emerging and Re-emerging Infectious Diseases
At least a dozen "new" diseases have been identified (such as AIDS, Legionnaire disease, Zika virus and hantavirus pulmonary syndrome), and traditional diseases that appeared to be "on their way out" (such as malaria and tuberculosis) are resurging. Globally, infectious diseases remain the leading cause of death, and they are the third leading cause of death in the United States. Clearly, the battle has not been won.
Emerging infectious diseases are diseases that (1) have not occurred in humans before (this type of emergence is difficult to establish and is probably rare); (2) have occurred previously but affected only small numbers of people in isolated places (AIDS and Ebola hemorrhagic fever are examples); or (3) have occurred throughout human history but have only recently been recognized as distinct diseases due to an infectious agent.
Re-emerging infectious diseases are diseases that once were major health problems globally or in a particular country, and then declined dramatically, but are again becoming health problems for a significant proportion of the population (malaria and tuberculosis are examples). Many specialists in infectious diseases include re-emerging diseases as a subcategory of emerging diseases. (1)
HISTORY
Emerging infections have been familiar threats since ancient times. They were once called lionos and later as pestilences, pests and plagues. Some examples can be sited like black death and 1918 influenza pandemic among many. The age of discovery, starting in fifteenth century was a particularly a disastrous period with regard to spread of infectious diseases. Importation of small pox in Mexico caused 10-25 million deaths in 1520-1521. Other American Indian and Pacific civilizations were destroyed by imported small pox and measles.
For centuries, mankind seemed helpless against these sudden epidemics. With the establishment of germ theory and the identification of specific microbes as the causative agent of wide variety if infectious diseases led to enormous progress, notably the development of vaccination and subsequently antimicrobials. By 1950s, which witnessed the wide spread use of penicillin, the development of polio vaccines and the discovery of drugs for tuberculosis, complacency had set in and the optimists at the end of 19th century predicted end of infectious disease era.
Some experts remained skeptical, aware of recurrent lessons from history. They were less persuaded by successes than alarmed by failures such as the lack of progress against infections in the developing world and the global spread of antimicrobial resistance. Emergence of AIDS- one of history’s most devastating pandemics, led to renewed appreciation of the inevitability and consequences of emerging infectious diseases. In past 25 years, some of the factors that resulted in AIDS have also led to re-emergence of historically important diseases such as cholera, diphtheria, trench fever, plague, influenza and most recently Zika virus. (2)
PUBLIC HEALTH CHALLENGES
Global distribution and prevalence
Emerging and re-emerging infectious diseases are more often found in developing and under developed countries. Their impact on morbidity and mortality is more severe in these populations and particularly on infants and children. About 15 million of 57 million annual deaths worldwide are estimated to be related directly to infectious diseases.
Challenges
Infectious diseases will continue to emerge and re-emerge leading to unpredictable epidemics and difficult challenges to public health. Surveillance and response, the key element in controlling emerging infectious diseases, depend on rapid clinical diagnosis and detection and contamination in populations and the environment. Globally, such efforts are coordinated by the world health organization. However, for developing countries economic constrain poses a great challenge for prevention and control of infectious diseases.
CAUSING AGENTS
There are five major types of infectious agents: bacteria, viruses, fungi, protozoa, helminthes and newly recognized prions. A brief review of the general characteristics of viral infections and examples of some diseases they cause follows.
Viruses
Microbiologists have found viruses that infect all organisms, from plants and animals to fungi and bacteria. Viruses, however, are not organisms themselves because, apart from a host cell, they have no metabolism and cannot reproduce.
Just like other infectious agents, viruses cause disease by disrupting normal cell function. They do this in a variety of ways. Some viruses make repressor proteins that stop the synthesis of the host cell's proteins, RNA, and DNA. Viral activity may weaken cell membranes and lysosomal membranes, leading to cell autolysis. Some viral proteins are toxic to cells, and the body's immune defenses also may kill virus-infected cells.
Viruses are classified using a variety of criteria, including shape, size, and type of genome. Among the DNA viruses are the herpes viruses that cause chicken pox, cold sores, and painful genital lesions, and the poxvirus that causes smallpox. Significant RNA viruses that cause human disease include rhinoviruses that cause most common colds; myxoviruses and paramyxoviruses that cause influenza, measles, and mumps; rotaviruses that cause gastroenteritis; and the retroviruses that cause AIDS and several types of cancer. (3)
FACTORS INFLUENCING THEIR FREQUENT REOCCURANCE
A number of factors contribute towards emergence and re-emergence of infectious diseased these include but are not limited to the following:
1. Disease reservoir. The reservoir for a disease is the site where the infectious agent survives. Animals often serve as reservoirs for these diseases that infect humans. The major reservoir for Yersinia pestis, the bacteria that causes plague, is wild rodents. There are also nonliving reservoirs. Since the reservoir animal can be completely eliminated in the environment, the disease is able to survive and re-emerge for example in case of Ebola.
2. Easy mode of transmission. Infectious agents may be transmitted through either direct or indirect contact. Direct contact occurs when an individual is infected by contact with the reservoir, for example, by touching an infected person, ingesting infected meat, or being bitten by an infected animal or insect. Transmission by direct contact also includes inhaling the infectious agent in droplets emitted by sneezing or coughing and contracting the infectious agent through intimate sexual contact. This makes the infection to easily transmitted between individuals.
3. Mutation and antimicrobial resistance. With times most of these infectious agents are able to mutate and acquire antimicrobial resistant genes. This has posed a great challenge to development of newer and stronger antimicrobial agents. Antimicrobial resistance contributes to great extend towards survival of emerging and re-emerging infections.
CONTROL METHODS
Developed countries have regulations that help protect the general public from infectious diseases. Public health measures typically involve eliminating the pathogen from its reservoir or from its route of transmission. Those measures include ensuring a safe water supply, effectively managing sewage treatment and disposal, and initiating food safety, animal control, and vaccination programs.
Safe water
Many pathogens that cause gastrointestinal diseases (for example, those that cause cholera and typhoid fever) are transmitted via water. Travelers to developing countries are frequently advised to be immunized against these diseases. There fore, water purification methods should be applied.
Because gastrointestinal pathogens typically leave the body in the feces, public water must be guarded against contamination from sewage. Municipal water is usually tested for the presence of coliform organisms (nonpathogenic microorganisms that are part of the normal flora of the gastrointestinal tract) as indicators of sewage contamination.
Sewage treatment and disposal
Sewage includes wash water, water from toilets, and storm run-off. These fluids may carry the pathogens for many waterborne diseases, including giardiasis and hepatitis A; therefore, to ensure public safety the U.S. government (and the governments of other developed countries) requires that sewage be treated to eliminate pathogens.
Food safety programs
In many developing and the developed country like the United States has many standards, inspection plans, and regulations about food preparation, handling, and distribution. Meat-packing facilities are inspected regularly to detect and eliminate diseased animals, ensure that standards for processes such as meat cutting and refrigeration are observed, and detect residues from pesticides and antibiotics as well as contamination by bacteria and other parasites. Restaurants and supermarkets are similarly inspected.
Animal control programs
Animals are carriers of many diseases that also affect humans. Inspecting domestic herd animals for tuberculosis (due to the bacterium Mycobacterium bovis) and brucellosis (a disease that causes spontaneous abortion in domestic herd animals and abscesses of the liver, spleen, bone marrow, and lymph nodes in humans) has helped eliminate the threat of passing the pathogens for those diseases to humans in contaminated milk and meat. Many diseases, including bubonic plague, are spread by rodents, and rat control, especially in urban areas, is a major component of public health efforts. Insects also transmit many diseases (a notable example is malaria). The spread of insect-borne diseases can be controlled by eliminating breeding areas for insects (for example, draining areas where stagnant water collects) and using pesticides. Many imported animals must be tested for specific diseases to prevent the introduction of those diseases into the country. (4)
Vaccination programs
The value of immunization for an individual's health is obvious; however, it is also important for public health. If a certain proportion of a population (called the threshold proportion) is immune to a disease, the pathogen that causes that disease will be unable to reproduce itself at a high enough level to maintain itself in the population. This is because once the infected host recovers or dies, there will not be enough new, susceptible hosts for the pathogen to infect. Eventually, the pathogen cannot spread any further and could be eliminated from the population. Even if elimination of the pathogen does not occur, there will be relatively few cases of the related disease and epidemics of the disease in the population will be avoided. This phenomenon is called herd immunity.
The threshold proportion varies depending on the disease and other conditions in the relevant population. Vaccination programs led by public health officials aim to achieve the immunization of at least the threshold number of individuals for the population. (5)
CONCLUSION
Emerging and re-emerging infectious diseases remain among the leading cause of death and disability worldwide. Against a constant background of established infections, epidemics of new and old infectious diseases periodically emerge, greatly magnifying the global burden of infections. Study of these infections reveal the evolutionary properties of pathogenic microorganisms and the dynamic relationships between microorganisms, their host and the environment.
They are the cause of serious global health problems.
This paper examined the trends of emerging and re-emerging infectious disease. and is examines (i) history of emerging and re-emerging infectious diseases, (ii) public health challenges, (iii) causing agents (iv)factors and control methods.
The reasons for the development of a control strategy based on population intervention rather than on individual treatment are discussed. An efficient vaccination program in most affected populations can reduce the morbidity and mortality caused by these emerging and re-emerging infectious diseases.
REFERENCE:
1. David M. Morens, Gregory K. Folkers and Anthony S. Fauci, National institute of Allergy and infectious diseases, 2004 Nature Publishing Group.
2. Anderson RM, May RM. Infectious diseases of humans: Dynamics and control. New York: Oxford University Press; 1992.
3. Biological Sciences Curriculum Study. Teaching tools. Dubuque, IA: Kendall/Hunt Publishing Company; 1999.
4. Bonwell CC, Eison JA. Active learning: Creating excitement in the classroom. Washington, DC: The George Washington University: School of Education and Human Development; 1991. (ASHE-ERIC Higher Education Report No. 1)
5. Brody CM. Collaborative or cooperative learning? Complementary practices for instructional reform. The Journal of Staff, Program, & Organizational Development. 1995;12(3):134–143.
An infectious disease is a disease that is caused by the invasion of a host by agents whose activities harm the host's tissues and can be transmitted to other individuals.
Infectious disease have for centuries ranked with wars and famine as major challenges to human progress and survival. They remain among the leading cause of death and disability worldwide. Against a constant background of established infections, epidemics of new and old infectious diseases periodically emerge, greatly magnifying the global burden of infections. Study of these infections reveal the evolutionary properties of pathogenic microorganisms and the dynamic relationships between microorganisms, their host and the environment.
Emerging and Re-emerging Infectious Diseases
At least a dozen "new" diseases have been identified (such as AIDS, Legionnaire disease, Zika virus and hantavirus pulmonary syndrome), and traditional diseases that appeared to be "on their way out" (such as malaria and tuberculosis) are resurging. Globally, infectious diseases remain the leading cause of death, and they are the third leading cause of death in the United States. Clearly, the battle has not been won.
Emerging infectious diseases are diseases that (1) have not occurred in humans before (this type of emergence is difficult to establish and is probably rare); (2) have occurred previously but affected only small numbers of people in isolated places (AIDS and Ebola hemorrhagic fever are examples); or (3) have occurred throughout human history but have only recently been recognized as distinct diseases due to an infectious agent.
Re-emerging infectious diseases are diseases that once were major health problems globally or in a particular country, and then declined dramatically, but are again becoming health problems for a significant proportion of the population (malaria and tuberculosis are examples). Many specialists in infectious diseases include re-emerging diseases as a subcategory of emerging diseases. (1)
HISTORY
Emerging infections have been familiar threats since ancient times. They were once called lionos and later as pestilences, pests and plagues. Some examples can be sited like black death and 1918 influenza pandemic among many. The age of discovery, starting in fifteenth century was a particularly a disastrous period with regard to spread of infectious diseases. Importation of small pox in Mexico caused 10-25 million deaths in 1520-1521. Other American Indian and Pacific civilizations were destroyed by imported small pox and measles.
For centuries, mankind seemed helpless against these sudden epidemics. With the establishment of germ theory and the identification of specific microbes as the causative agent of wide variety if infectious diseases led to enormous progress, notably the development of vaccination and subsequently antimicrobials. By 1950s, which witnessed the wide spread use of penicillin, the development of polio vaccines and the discovery of drugs for tuberculosis, complacency had set in and the optimists at the end of 19th century predicted end of infectious disease era.
Some experts remained skeptical, aware of recurrent lessons from history. They were less persuaded by successes than alarmed by failures such as the lack of progress against infections in the developing world and the global spread of antimicrobial resistance. Emergence of AIDS- one of history’s most devastating pandemics, led to renewed appreciation of the inevitability and consequences of emerging infectious diseases. In past 25 years, some of the factors that resulted in AIDS have also led to re-emergence of historically important diseases such as cholera, diphtheria, trench fever, plague, influenza and most recently Zika virus. (2)
PUBLIC HEALTH CHALLENGES
Global distribution and prevalence
Emerging and re-emerging infectious diseases are more often found in developing and under developed countries. Their impact on morbidity and mortality is more severe in these populations and particularly on infants and children. About 15 million of 57 million annual deaths worldwide are estimated to be related directly to infectious diseases.
Challenges
Infectious diseases will continue to emerge and re-emerge leading to unpredictable epidemics and difficult challenges to public health. Surveillance and response, the key element in controlling emerging infectious diseases, depend on rapid clinical diagnosis and detection and contamination in populations and the environment. Globally, such efforts are coordinated by the world health organization. However, for developing countries economic constrain poses a great challenge for prevention and control of infectious diseases.
CAUSING AGENTS
There are five major types of infectious agents: bacteria, viruses, fungi, protozoa, helminthes and newly recognized prions. A brief review of the general characteristics of viral infections and examples of some diseases they cause follows.
Viruses
Microbiologists have found viruses that infect all organisms, from plants and animals to fungi and bacteria. Viruses, however, are not organisms themselves because, apart from a host cell, they have no metabolism and cannot reproduce.
Just like other infectious agents, viruses cause disease by disrupting normal cell function. They do this in a variety of ways. Some viruses make repressor proteins that stop the synthesis of the host cell's proteins, RNA, and DNA. Viral activity may weaken cell membranes and lysosomal membranes, leading to cell autolysis. Some viral proteins are toxic to cells, and the body's immune defenses also may kill virus-infected cells.
Viruses are classified using a variety of criteria, including shape, size, and type of genome. Among the DNA viruses are the herpes viruses that cause chicken pox, cold sores, and painful genital lesions, and the poxvirus that causes smallpox. Significant RNA viruses that cause human disease include rhinoviruses that cause most common colds; myxoviruses and paramyxoviruses that cause influenza, measles, and mumps; rotaviruses that cause gastroenteritis; and the retroviruses that cause AIDS and several types of cancer. (3)
FACTORS INFLUENCING THEIR FREQUENT REOCCURANCE
A number of factors contribute towards emergence and re-emergence of infectious diseased these include but are not limited to the following:
1. Disease reservoir. The reservoir for a disease is the site where the infectious agent survives. Animals often serve as reservoirs for these diseases that infect humans. The major reservoir for Yersinia pestis, the bacteria that causes plague, is wild rodents. There are also nonliving reservoirs. Since the reservoir animal can be completely eliminated in the environment, the disease is able to survive and re-emerge for example in case of Ebola.
2. Easy mode of transmission. Infectious agents may be transmitted through either direct or indirect contact. Direct contact occurs when an individual is infected by contact with the reservoir, for example, by touching an infected person, ingesting infected meat, or being bitten by an infected animal or insect. Transmission by direct contact also includes inhaling the infectious agent in droplets emitted by sneezing or coughing and contracting the infectious agent through intimate sexual contact. This makes the infection to easily transmitted between individuals.
3. Mutation and antimicrobial resistance. With times most of these infectious agents are able to mutate and acquire antimicrobial resistant genes. This has posed a great challenge to development of newer and stronger antimicrobial agents. Antimicrobial resistance contributes to great extend towards survival of emerging and re-emerging infections.
CONTROL METHODS
Developed countries have regulations that help protect the general public from infectious diseases. Public health measures typically involve eliminating the pathogen from its reservoir or from its route of transmission. Those measures include ensuring a safe water supply, effectively managing sewage treatment and disposal, and initiating food safety, animal control, and vaccination programs.
Safe water
Many pathogens that cause gastrointestinal diseases (for example, those that cause cholera and typhoid fever) are transmitted via water. Travelers to developing countries are frequently advised to be immunized against these diseases. There fore, water purification methods should be applied.
Because gastrointestinal pathogens typically leave the body in the feces, public water must be guarded against contamination from sewage. Municipal water is usually tested for the presence of coliform organisms (nonpathogenic microorganisms that are part of the normal flora of the gastrointestinal tract) as indicators of sewage contamination.
Sewage treatment and disposal
Sewage includes wash water, water from toilets, and storm run-off. These fluids may carry the pathogens for many waterborne diseases, including giardiasis and hepatitis A; therefore, to ensure public safety the U.S. government (and the governments of other developed countries) requires that sewage be treated to eliminate pathogens.
Food safety programs
In many developing and the developed country like the United States has many standards, inspection plans, and regulations about food preparation, handling, and distribution. Meat-packing facilities are inspected regularly to detect and eliminate diseased animals, ensure that standards for processes such as meat cutting and refrigeration are observed, and detect residues from pesticides and antibiotics as well as contamination by bacteria and other parasites. Restaurants and supermarkets are similarly inspected.
Animal control programs
Animals are carriers of many diseases that also affect humans. Inspecting domestic herd animals for tuberculosis (due to the bacterium Mycobacterium bovis) and brucellosis (a disease that causes spontaneous abortion in domestic herd animals and abscesses of the liver, spleen, bone marrow, and lymph nodes in humans) has helped eliminate the threat of passing the pathogens for those diseases to humans in contaminated milk and meat. Many diseases, including bubonic plague, are spread by rodents, and rat control, especially in urban areas, is a major component of public health efforts. Insects also transmit many diseases (a notable example is malaria). The spread of insect-borne diseases can be controlled by eliminating breeding areas for insects (for example, draining areas where stagnant water collects) and using pesticides. Many imported animals must be tested for specific diseases to prevent the introduction of those diseases into the country. (4)
Vaccination programs
The value of immunization for an individual's health is obvious; however, it is also important for public health. If a certain proportion of a population (called the threshold proportion) is immune to a disease, the pathogen that causes that disease will be unable to reproduce itself at a high enough level to maintain itself in the population. This is because once the infected host recovers or dies, there will not be enough new, susceptible hosts for the pathogen to infect. Eventually, the pathogen cannot spread any further and could be eliminated from the population. Even if elimination of the pathogen does not occur, there will be relatively few cases of the related disease and epidemics of the disease in the population will be avoided. This phenomenon is called herd immunity.
The threshold proportion varies depending on the disease and other conditions in the relevant population. Vaccination programs led by public health officials aim to achieve the immunization of at least the threshold number of individuals for the population. (5)
CONCLUSION
Emerging and re-emerging infectious diseases remain among the leading cause of death and disability worldwide. Against a constant background of established infections, epidemics of new and old infectious diseases periodically emerge, greatly magnifying the global burden of infections. Study of these infections reveal the evolutionary properties of pathogenic microorganisms and the dynamic relationships between microorganisms, their host and the environment.
They are the cause of serious global health problems.
This paper examined the trends of emerging and re-emerging infectious disease. and is examines (i) history of emerging and re-emerging infectious diseases, (ii) public health challenges, (iii) causing agents (iv)factors and control methods.
The reasons for the development of a control strategy based on population intervention rather than on individual treatment are discussed. An efficient vaccination program in most affected populations can reduce the morbidity and mortality caused by these emerging and re-emerging infectious diseases.
REFERENCE:
1. David M. Morens, Gregory K. Folkers and Anthony S. Fauci, National institute of Allergy and infectious diseases, 2004 Nature Publishing Group.
2. Anderson RM, May RM. Infectious diseases of humans: Dynamics and control. New York: Oxford University Press; 1992.
3. Biological Sciences Curriculum Study. Teaching tools. Dubuque, IA: Kendall/Hunt Publishing Company; 1999.
4. Bonwell CC, Eison JA. Active learning: Creating excitement in the classroom. Washington, DC: The George Washington University: School of Education and Human Development; 1991. (ASHE-ERIC Higher Education Report No. 1)
5. Brody CM. Collaborative or cooperative learning? Complementary practices for instructional reform. The Journal of Staff, Program, & Organizational Development. 1995;12(3):134–143.
Sandy
profile/4586Capturenn.PNG
Sandy
Boost Your NBME Self Assessment Scores For The USMLE, Minimize Lost Points
~5.8 mins read
So Here is what I did to boost my assessment scores from 240 in NBMEs 13, 15, 16 to 257 in NBME 18: maybe it helps you too if you do the same:
1- (VERY IMPORTANT METHOD) Read all choices in a question and CROSS OUT the other choices, don't only choose what u believe is right (even if it is so simple and obvious) we easily lose some question by not doing that, when you read the other choices, see why they r not the correct choice then cross them out (for example disease affects children and case is elderly, or the case does not have a cardinal symptom or a must physical finding is not present or ….or… etc) this exclusion strategy really made my mistakes go less. THIS ADVICE IS THE EASIEST TO DO AND SAVES U SOME MANY QUESTIONS, TRAIN YOURSELF NOW ON THAT WHEN YOU DO A BLOCK OF UW PLEASE, SO YOU CAN IMPLEMENT THAT ON THE EXAM DAY.
The long message below I sent to a member for the same reason (boost performance in the few weeks left before her exam (the more time you have the better of course) , please read it and give it a try, it helped me to boost my NBME results as I shared above.
You need to make notes of all wrong questions in each NBME (immediately after you do the NBME). So you know out of 200 total questions you have for example 30 questions wrong and 170 right. I did that & I noticed that wrong questions in NBME or any assessment are spread over 3 categories, these 3 categories are:
1-Weird Questions you going to get wrong anyway (no time to invest working on these), even those who scores 260+ have these mistakes
2-Silly Mistakes you know the answer to them but somehow you were just not focused, But you are so sure about the answer and somehow you did not notice a word, or missed a lab value, and so on, so YOUR CONCEPOTS HERE R INTACT (same no time to invest her).
3-Questions you get wrong because their concepts is not very solid in your brain.(This is where you invest your coming days, i.e. on topics you have mistaken in these questions) It will definitely boost your score). & when I say these topics, I don’t mean only the question point, rather the whole sub-subject, for example you got a question wrong about epithelial ovarian tumors (then you need to do all OVARIAN TUMERS) and ask yourself do you feel Testicular tumors are in a hazy area for you as well, then it should be a target for you as well, hammer these topics from head to toe.
How to apply the fix for point 3 above:
You need 1 full day to analyze: note the questions that were wrong in the NBME (what was the question? (CVS, Renal, Repro, Micro, Biochem, etc) and then what is the sub-section of that same questiuon ie ( Anatomy, Physio, Patho or Pharma) this is for systems, for generals (if biochem ( was it Vitamines, Hoemones, Purin Metabolism) for Micro was Viro, Bacterio, Fungi etc.
See that I count individual questions and I don’t rely totally on the performance page, because as I said some questions are just so wiered never seen in UW, and you may get similar questions on the exam wrong anyway (these are very few questions but the affect these bar performance so I can not rely on the bars of NBME report alone, some for silly mistakes in subject X for example, the bar of that subject will be low, but these are not a concept weakness issues, you are good if you implement the CROSS OUT METHOD and that is it. THAT IS WHY IT IS BETTER IF YOU COUNT AND SEE WHICH ARE THE QUESTIONS THAT FALL IN CATEGORY 3 (CONCEPT PROBLEM) TO WORK ON THEM.
so for example when I analyzed my problem then: it was Repro (Physio & Patho), Hemato (Patho) Endo (Patho), Biosts (all equation stuff and even Bios studies), Genetics ( genetic tests ELISA and CPR stuff) and Genetics in general. After that analysis phase of the problem now we go to: Treatment phase.
Treatment phase (I will continue using my weak areas as an example here) BRS physio for Repro Pathoma Repro section Book only, UW Repro (Patho & Physio) create custom test for these subjects and finish them WITH RATIONAL, biggest mistake at this stage is that we do questions and skip rational, but you need to IMPROVE, so scan the rational with your eyes and spend time with the points that makes this topic STILL a weak area for you, it is all about UNDERSTANDING & REPETITION.
This treatment phase needs to be done with no gaps, study all using resources you respect and love in sane time fast (Dr. Najeeb cannot help in this phase cos with respect to his great knowledge and super teaching skills it will take you forever and your exam is close I assume), After the study phase do UW of these topics, here in my example UW Repro physio and Patho systems only ( to do that all you need to do is mark all questions in your UW done blocks ( if you did in the random phase, or if you are in the subject/system phase, so just go to these already done blocks of that system and mark them, then create tests using marked pool only, every question goes into a new test will be unmarked automatically by the system. So you will do them all without any question repeated for you)
To improve my low performance in Genetics I did B&B videos and then its PDF read twice and did only equation questions (cos my mistakes were here (bars will not show you that) out of all 81 genetics questions (skipped non equation ones), for Biostat (I watched B&B biostat videos I guess total 3 hours) I watched these 2 times, to understand them and went over its PDF, then did all biostat questions in UW online (created test for biosts only) and now I got 1 wrong out of 66 questions ( I did not believe that) but I read all RATIONAL OF THESE 66 QUESTIONS, scanned what I know, my eyes went over every line in the rational, this strategy improved my performance hugely in almost 10 days So if you focus on the weak areas seen by the lenses of the NBME (INDIVIDUAL WRONG QUESTIONS), you check wrong questions yourself, and put them into which subject and what system, to which topic you need to bombard heavily now, you may need to stop UW for these days, I stopped UW at 2/3 of second round to do that, and later just solved the reaming one 1/3 and only checked the rational of wrong questions and some of questions that consumed more than 100 sec, Also Leave an assessment or 2 to the end like 4 days before exam, I continued my prep as If I am going to sit the exam in its scheduled day, but I said if my score in assessment did not reach 250 I will postpone (though I was at the end of my extended period ( May - Oct) and thought to cancel, but My last 2 NBMEs 18 was 257 and 19 was 248 (which underestimates) and UWSA 2 was 272, so I thought ok I can go to the exam. though that was my decision you make your own decision and work hard as if you are going to go for it in its specified day. Also you can tell which areas you need to work on by your level of hate to that topic, so if you hate it, work on it hard during preparation time, DON’T JUST SKIP IT FACE YOUR ENIMIES (THESE CRAZY TOPICS I MEAN) If you skip them now, they will give you headache on your assessment exams and sure on the real exam itself, go bombard its material (not in 1st aide rather in a source like BRS for physio, pathoma for Patho, etc). ALL BEST OF LUCK, and sorry for explain with example but u take this test one time and I wanted to make sure I convey my idea thoroughly, It really helped me so it may help YOU.
IT IS OK TO FEEL LOST, DEPRESSED, NOT COMPETENT ENOUGH FOR THIS TEST, EVEN 270 scorers feel that. JUST STAY STRONG AND KEEP WORKING HARD BUT ALSO SMARTLY, YOU WILL ACE THIS EXAM.
GOOD LUCK TO ALL OF YOU.
1- (VERY IMPORTANT METHOD) Read all choices in a question and CROSS OUT the other choices, don't only choose what u believe is right (even if it is so simple and obvious) we easily lose some question by not doing that, when you read the other choices, see why they r not the correct choice then cross them out (for example disease affects children and case is elderly, or the case does not have a cardinal symptom or a must physical finding is not present or ….or… etc) this exclusion strategy really made my mistakes go less. THIS ADVICE IS THE EASIEST TO DO AND SAVES U SOME MANY QUESTIONS, TRAIN YOURSELF NOW ON THAT WHEN YOU DO A BLOCK OF UW PLEASE, SO YOU CAN IMPLEMENT THAT ON THE EXAM DAY.
The long message below I sent to a member for the same reason (boost performance in the few weeks left before her exam (the more time you have the better of course) , please read it and give it a try, it helped me to boost my NBME results as I shared above.
You need to make notes of all wrong questions in each NBME (immediately after you do the NBME). So you know out of 200 total questions you have for example 30 questions wrong and 170 right. I did that & I noticed that wrong questions in NBME or any assessment are spread over 3 categories, these 3 categories are:
1-Weird Questions you going to get wrong anyway (no time to invest working on these), even those who scores 260+ have these mistakes
2-Silly Mistakes you know the answer to them but somehow you were just not focused, But you are so sure about the answer and somehow you did not notice a word, or missed a lab value, and so on, so YOUR CONCEPOTS HERE R INTACT (same no time to invest her).
3-Questions you get wrong because their concepts is not very solid in your brain.(This is where you invest your coming days, i.e. on topics you have mistaken in these questions) It will definitely boost your score). & when I say these topics, I don’t mean only the question point, rather the whole sub-subject, for example you got a question wrong about epithelial ovarian tumors (then you need to do all OVARIAN TUMERS) and ask yourself do you feel Testicular tumors are in a hazy area for you as well, then it should be a target for you as well, hammer these topics from head to toe.
How to apply the fix for point 3 above:
You need 1 full day to analyze: note the questions that were wrong in the NBME (what was the question? (CVS, Renal, Repro, Micro, Biochem, etc) and then what is the sub-section of that same questiuon ie ( Anatomy, Physio, Patho or Pharma) this is for systems, for generals (if biochem ( was it Vitamines, Hoemones, Purin Metabolism) for Micro was Viro, Bacterio, Fungi etc.
See that I count individual questions and I don’t rely totally on the performance page, because as I said some questions are just so wiered never seen in UW, and you may get similar questions on the exam wrong anyway (these are very few questions but the affect these bar performance so I can not rely on the bars of NBME report alone, some for silly mistakes in subject X for example, the bar of that subject will be low, but these are not a concept weakness issues, you are good if you implement the CROSS OUT METHOD and that is it. THAT IS WHY IT IS BETTER IF YOU COUNT AND SEE WHICH ARE THE QUESTIONS THAT FALL IN CATEGORY 3 (CONCEPT PROBLEM) TO WORK ON THEM.
so for example when I analyzed my problem then: it was Repro (Physio & Patho), Hemato (Patho) Endo (Patho), Biosts (all equation stuff and even Bios studies), Genetics ( genetic tests ELISA and CPR stuff) and Genetics in general. After that analysis phase of the problem now we go to: Treatment phase.
Treatment phase (I will continue using my weak areas as an example here) BRS physio for Repro Pathoma Repro section Book only, UW Repro (Patho & Physio) create custom test for these subjects and finish them WITH RATIONAL, biggest mistake at this stage is that we do questions and skip rational, but you need to IMPROVE, so scan the rational with your eyes and spend time with the points that makes this topic STILL a weak area for you, it is all about UNDERSTANDING & REPETITION.
This treatment phase needs to be done with no gaps, study all using resources you respect and love in sane time fast (Dr. Najeeb cannot help in this phase cos with respect to his great knowledge and super teaching skills it will take you forever and your exam is close I assume), After the study phase do UW of these topics, here in my example UW Repro physio and Patho systems only ( to do that all you need to do is mark all questions in your UW done blocks ( if you did in the random phase, or if you are in the subject/system phase, so just go to these already done blocks of that system and mark them, then create tests using marked pool only, every question goes into a new test will be unmarked automatically by the system. So you will do them all without any question repeated for you)
To improve my low performance in Genetics I did B&B videos and then its PDF read twice and did only equation questions (cos my mistakes were here (bars will not show you that) out of all 81 genetics questions (skipped non equation ones), for Biostat (I watched B&B biostat videos I guess total 3 hours) I watched these 2 times, to understand them and went over its PDF, then did all biostat questions in UW online (created test for biosts only) and now I got 1 wrong out of 66 questions ( I did not believe that) but I read all RATIONAL OF THESE 66 QUESTIONS, scanned what I know, my eyes went over every line in the rational, this strategy improved my performance hugely in almost 10 days So if you focus on the weak areas seen by the lenses of the NBME (INDIVIDUAL WRONG QUESTIONS), you check wrong questions yourself, and put them into which subject and what system, to which topic you need to bombard heavily now, you may need to stop UW for these days, I stopped UW at 2/3 of second round to do that, and later just solved the reaming one 1/3 and only checked the rational of wrong questions and some of questions that consumed more than 100 sec, Also Leave an assessment or 2 to the end like 4 days before exam, I continued my prep as If I am going to sit the exam in its scheduled day, but I said if my score in assessment did not reach 250 I will postpone (though I was at the end of my extended period ( May - Oct) and thought to cancel, but My last 2 NBMEs 18 was 257 and 19 was 248 (which underestimates) and UWSA 2 was 272, so I thought ok I can go to the exam. though that was my decision you make your own decision and work hard as if you are going to go for it in its specified day. Also you can tell which areas you need to work on by your level of hate to that topic, so if you hate it, work on it hard during preparation time, DON’T JUST SKIP IT FACE YOUR ENIMIES (THESE CRAZY TOPICS I MEAN) If you skip them now, they will give you headache on your assessment exams and sure on the real exam itself, go bombard its material (not in 1st aide rather in a source like BRS for physio, pathoma for Patho, etc). ALL BEST OF LUCK, and sorry for explain with example but u take this test one time and I wanted to make sure I convey my idea thoroughly, It really helped me so it may help YOU.
IT IS OK TO FEEL LOST, DEPRESSED, NOT COMPETENT ENOUGH FOR THIS TEST, EVEN 270 scorers feel that. JUST STAY STRONG AND KEEP WORKING HARD BUT ALSO SMARTLY, YOU WILL ACE THIS EXAM.
GOOD LUCK TO ALL OF YOU.
Abel
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Abel
Medcine Mnemonics For Internal Medicine And Beyond
~17.6 mins read
These Medicine mnemonics would help you in Internal Medicine rotations.
The best part is a huge chunk of the all medical professional exams are from Internal medicine.
It is safe to say then, that these mnemonics would help you your entire life as a Medical student and Doctor.
Pancytopaenia differential
"All Of My Blood Has Taken Some Poison":
Aplastic anaemias
Overwhelming sepsis
Megaloblastic anaemias
Bone marrow infiltration
Hypersplenism
TB
SLE
Paroxysmal nocturnal haemoglobinuria
Haematology: key numbers
3 and 4 are key in in haematology:
1.34 cm3 of oxygen is carried by a gram of hemoglobin.
There's 3.4mg of iron in each gram of hemoglobin.
There's an average of 3.4 lobes per neutrophil.
There's 34mg bilirubin from each gram of hemoglobin.
Back trouble causes
O, VERSALIUS (Versalius was the name of a famous physician):
Osteomyelitis
Vertebral fracture
Extraspinal tumour
Spondylolisthesis
Ankylosing spondylitis
Lumbar disk increase
Intraspinal tumor
Unhappiness
Stress
Sports injuries: course of action RICE:
Rest
Ice
Compression
Elevation
· RICE especially for fractures, sprains, muscle strains, contusions
· Alternatively: I=Immobilization, C=Cold compresses.
Back pain causes DISK MASS (since near vertebral disc):
Degeneration (DJD, osteoporosis, spondylosis)
Infection (UTI, PID, Pott's disease, osteomyelitis, prostatitis)/ Injury, fracture or compression fracture
Spondylitis (ankylosing spondyloarthropathies such as rheumatoid arthritis, Reiters, SLE)
Kidney (stones, infarction, infection)
Multiple myeloma/ Metastasis (from cancers of breast, kidney, lung, prostate, thyroid)
Abdominal pain (referred to the back)/ Aneurysm
Skin (herpes zoster)/ Strain/ Scoliosis and lordosis Slipped disk/ Spondylolisthesis
Bronchiectasis: differential BRONCHIECTASIS:
Bronchial cyst
Repeated gastric acid aspiration
Or due to foreign bodies
Necrotizing pneumonia
Chemical corrosive substances
Hypogammaglobulinemia
Immotile cilia syndrome
Eosinophilia (pulmonary)
Cystic fibrosis
Tuberculosis (primary)
Atopic bronchial asthma
Streptococcal pneumonia
In Young's syndrome
Staphylococcal pneumonia
Sickle cell disease complications SICKLE:
Strokes/ Swelling of hands and feet/ Spleen problems
Infections/ Infarctions
Crises (painful, sequestration, aplastic)/ Cholelithiasis/ Chest syndrome/ Chronic hemolysis/ Cardiac problems
Kidney disease
Liver disease/ Lung problems
Erection (priapism)/ Eye problems (retinopathy)
ADP: role in platelet aggregation
ADP = Aggregation from the Dense bodies of Platelets.
Gynecomastia: common causes GYNECOMASTIA:
Genetic Gender disorder (Klinefelter)
Young boy (pubertal)*
Neonate*
Estrogen
Cirrhosis/ Cimetidine/ Ca Channel blockers
Old age*
Marijuana
Alcoholism
Spironolactone
Tumors (Testicular & adrenal)
Isoniazid/ Inhibition of testosterone
Antineoplastics (Alkylating Agents)/ Antifungal(ketoconazole)
· * Asterisk indicates physiologic cause.
Lethargy, malaise causes FATIGUED:
Fat/ Food (poor diet)
Anemia
Tumor
Infection (HIV, endocarditis)
General joint or liver disease
Uremia
Endocrine (Addison's, myxedema)
Diabetes/ Depression/ Drugs
Polycythemia Rubra Vera (PRV): common symptoms
PRV:
Plethora/ Pruritis
Ringing in ears
Visual blurriness
Rashes: time of appearance after fever onset
"Really Sick Children Must Take No Exercise":
· Number of days after fever onset that a rash will appear:
1 Day: Rubella
2 Days: Scarlet fever/ Smallpox
3 Days: Chickenpox
4 Days: Measles (and see the Koplik spots one day prior to rash)
5 Days: Typhus & rickettsia (this is variable)
6 Days: Nothing
7 Days: Enteric fever (salmonella)
Anion gap metabolic acidosis: causes
A MUDPILE CAT:
Alcohol
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Iron/ Isoniazid
Lactic acidosis
Ethylene glycol
Carbamazepine
Aspirin
Toluene
Bronchiectasis: causes
A SICK AIRWAY:
Airway lesion, chronic obstruction
Sequestration
Infection, inflamation
Cystic fibrosis
Kartagners syndrome
Allergic brochopulmonary aspergilliosis
Immunodeficiencies (hypogammaglobinaemia, myeloma, lymphoma)
Reflux, inhalation injury
William Campbell syndrome (and other congenitals)
Aspiration
Yellow nail syndrome/ Young syndrome
Alkalosis: metabolic changes in alkalosis
"Al-K-loss, Al-Ca-loss": There is loss of K+ (hypokalemia) and Ca++ (hypocalcemia) in state of alkalosis.
HbA2: concentration in normal blood
HbA2: Concentration of HbA2 is 2% in normal adult blood.
Ducket John's: major criteria
ACNES:
Arthritis
Carditis
Nodule (subcutaneous)
Erythrema marginatum
Sydenham chorea
ICU management: A to Z
A: Asepsis/ Airway
B: Bed sore/ encourage Breathing/ Blood pressure
C: Circulation/ encourage Coughing/ Consciousness
D: Drains
E: ECG
F: Fluid status
G: GI losses/ Gag reflex
H: Head positioning/ Height
I: Insensible losses
J: Jugular venous pulse
K: Kindness
L: Limb care/ Label
M: Mouth care
N: Nociception/ Nutrition
O: Oxygenation/ Orient the patient
P: Pulse/ Peristalsis/ Physiotherapy
Q: Quiet surroundings
R: Respiratory rate/ Restraint
S: Stress ulcer/ Suctioning
T: Temperature
U: Urine
V: Ventilator
W: Wounds/ Weight
X: Xerosis
Y: whY
Z: Zestful care of the patient
Hypercalcemia causes
MD PIMPS ME:
Malignancy
Diuretics (thiazide the main culprit)
Parathyroid (hyperparathyroidism)
Immobilization/ Idiopathic
Megadoses of vitamins A,D
Paget's disease
Sarcoidosis
Milk alkali syndrome
Endocrine (Addison's disease, thyrotoxicosis)
Left iliac fossa: causes of pain
SUPER CLOT:
Sigmoid diverticulitis
Uteric colic
PID
Ectopic pregnancy
Rectus sheath haematoma
Colorectal carcinoma
Left sided lower love pneumonia
Ovarian cyst (rupture, torture)
Threatened abortion/ Testicular torsion
Respiratory disease: hand signs CASH:
Clubbing
Asterixis
Small muscle wasting
HPOA
Clubbing: respiratory causes
ABCDEF:
Abcess (lung)
Bronchiectasis (including CF)
Cancer (lung)
Decreased oxygen (hypoxia)
Empyaema
Fibrosing alveolitis
Pulmonary edema: treatments MAD DOG:
Morphine
Aminophylline
Digitalis
Diuretics
Oxygen
GGases in blood (ABG's)
Hypercalcemia: causes GRIM FED:
Granulomas (sarcoid, TB),
Renal faliure
Immobility (esp. long term)
Malignancy
Familial (eg familial hypocalciuric hypercalcemia)
Endocrine (see below for subtypes)
Drugs (esp. thiazide diuretics, lithium)
· Endocrine causes are PATH:
Phaeochromocytoma
Addison's disease
Thyrotoxicosis
Hyperparathyroidism
Acute stridor: differentialABCDE’FGH:
· With fever: Abscess Bacterial tracheitis Croup Diphtheria Epiglottitis
· Without fever: Foreign body Gas (Toxic Gas) Hypersensitivity
Hypercalcemia: differential VITAMIN TRAPS:
Vitamin A and D intoxication
Immobilization
Thyrotoxicosis
Addison's disease/ Acidosis
Milk-alkali syndrome
Inflammatory disorders
Neoplastic disease
Thiazides, other drugs
Rhabdomyolysis
AIDS
Paget's disease/ Parenteral nutrition/ Parathyroid disease
Metabolic acidosis: causes USED CAR:
Ureteroenterostomy
Saline hydration
Endocrinopathies (hyperparathyroid, hyperthyroid, Addison's)
Diarrhea/ DKA/ Drugs
Carbonic anhydrase inhibitors
Ammonium chloride
Renal tubular acidosis
· Alternatively: USED CARP, to include
Parenteral nutrition/ Pancreatic fistula.
Pulmonary edema: treatment LMNOP:
Lasix
Morphine
Nitrates (NTG)
Oxygen
Position (upright vs. flat)
Eosinophilia: differential NAACP:
Neoplasm
Allergy/ Asthma Addison's disease
Collagen vascular diseases
Parasites
SIADH: diagnostic sign
Syndrome of INAPPropriate Anti-Diuretic Hormone:
Increased
Na (sodium)
PP (urine)
· SIADH is characterized by increased urinary sodium.
Thyroid storm: initial management PCP'S:
PTU - 1 gm po
Corticosteroids
Propranolol
SSKI
Renal failure (acute): management
Manage AEIOU:
Anemia/ Acidosis
Electrolyte and fluids
Infections
Other measures (eg nutrition, nausea, vomiting
Uremia
Non-gap acidosis: causes HARD UP:
Hyperalimentation
Acetazolamide (carbonic anhydrase inhibitors)
RTA
Diarrhea
Ureterosigmoidostomy
Pancreatic fistula
Hemoptysis: causes HEMOPTYSIS:
Haemorrhagic diathesis
Edema [LVF due to mitral stenosis]
Malignancy
Others [eg: vasculitis]
Pulmonary vascular abnormalities
Trauma
Your treatment [anticoagulants]
SLE
Infarction in lungs
Septic
Abdominal pain: medical causes "ABDOMENAL PANE" [abdominal pain]:
Acute rheumatic fever
Blood [purpura, a/c hemolytic crisis]
DKA
cOllagen vascular disease
Migraine [abdominal migraine]
Epilepsy [abdominal epilepsy]
Nephron [uremia]
Abdominal angina
Lead
Porphyria
Arsenic
NSAID's
Enteric fever
Haemobilia: features MOB:
Melaena Obstructive jaundice Biliary colic
Thickened nerves: causes
HANDS:
Hansen's (leprosy)
Amyloidosis
Neurofibromatosis
Diabetes mellitus
Sarcoidosis
SIADH: major signs and symptoms
SIADH:
Spasms
Isn't any pitting edema (key DDx)
Anorexia
Disorientation (and other psychoses)
Hyponatremia
Toxicity/ sepsis: signs 6 T's:
Tachycardia
Tachypnea
Tremors
Toxic look
Tiredness
Temperature (fever)
Macrocytic anemia: causes ABCDEF:
Alcohol + liver disease
B12 deficiency
Compensatory reticulocytosis (blood loss and hemolysis)
Drug (cytotoxic and AZT)/ Dysplasia (marrow problems)
Endocrine (hypothyroidism)
Folate deficieny/ Fetus (pregnancy)
Behcet's syndrome: diagnostic criteria
PROSE:
Pathergy test (i/d saline injection)
Recurrent genital ulceration
Oral ulceration (recurrent)
Skin lesions
Eye lesions
· Oral ulceration is central criteria, plus any 2 others.
Metabolic acidosis: causes KUSSMAL:
Ketoacidosis
Uraemia
Sepsis
Salicylates
Methanol
Alcohol
Lactic acidosis
Allopurinol: indications STORE:
Stones (history of renal stones)
Tophaceous gout (chronic)
Over-producers of urate
Renal disease
Elderly
Bonus: Probenecid indications are basically the opposite of STORE (no renal stone history, etc.).
Raynaud's disease: causes BAD CT:
Blood disorders (eg polycythaemia)
Arterial (eg atherosclerosis, Buerger's)
Drugs (eg beta-blockers)
Connective tissue disorders (rheumatoid arthritis, SLE)
Traumatic (eg vibration injury)
Lead poisoning (chronic): features ABCDEFGHI:
Anaemia/ Anorexia/ Arthralgia/ Abortion/ Atrophy of optic nerve
Basophilic stippling of RBC (punctate basophilia)/ Burtonian line on gums
Colic/ Constipation/ Coprophyrin excess in urine/ Cerebraloedema
Drop (wrist, foot)
Encephalopathy/ Emaciation
Foul smell of breath/ Failure of kidneys/ Fanconi syndrome
Gonadal dysfunction/ Gout-like picture
High BP/ Headache/ Hallucination/ Hyperaesthesia
Impotence/ Insomnia/ Irritability
Splenomegaly: causes CHICAGO:
Cancer Hem, onc Infection Congestion (portal hypertension) Autoimmune (RA, SLE) Glycogen storage disorders Other (amyloidosis)
SIADH: causes SIADH:
Surgery
Intracranial: infection, head injury, CVA
Alveolar: Ca, pus
Drugs: opiates,antiepileptics, cytotoxics, anti-psychotics
Hormonal: hypothyroid, low corticosteroid level
Ileus: causes MD SPUGERS:
Mesenteric ischemia
Drugs (see below)
Surgical (post-op)
Peritonitis/ Pancreatitis (sentinnel loop)
Unresolved mechanical obstruction (eg mass, intussusception, blockage)
Gram negative sepsis
Electrolyte imbalance (eg hypokalemia)
Retroperitoneal bleed or hematoma
Spinal or pelvic fracture
· Drugs are Aluminum hydroxide, Ba++, Ca carbonate, opiates, TCA, verapamil.
Ulcers: types VAN:
Venous/ Vasculitic
Arterial
Neuropathic
Pulmonary fibrosis: causes SCAR:
· Upper lobe:
Silicosis/ Sarcoidosis
Coal worker pneumonconiosis
Ankylosing spondylitis
Radiation
· Lower lobe:
Systemic sclerosis
Cyptogenic fibrosing alveolitis
Asbetosis
Rheumatoid arthritis
Dialysis indications HAVE PEE:
Hyperkalemia (refractory)
Acidosis (refractory)
Volume overload
Elevated BUN (> 36 mM)
Pericarditis
Encephalopathy
Edema (pulmonary)
SLE: factors that make SLE active UV PRISM:
UV (sunshine)
Pregnancy
Reduced drug (eg steroid)
Infection
Stress
More drug
Pruritus without rash: Ddx
ITCHING DX:
Infections (scabies, toxocariasis, etc)
Thyroidal and other endocrinopathies (eg diabetes mellitus)
Cancer
Hematologic diseases (eg iron deficiency)/ Hepatopathies/ HIV
Idiopathic
Neurotic
Gravid (pruritus of pregancy)
Drugs
eXcretory dysfunctions (eg uremia)
Horner's syndrome: components SAMPLE:
Sympathetic chain injury
Anhidrosis
Miosis
Ptosis
Loss of ciliospinal reflex
Enophthalmos
Caplan syndrome: characteristics CAPlan:
Coal worker pneumoconiosis
Arthritis
Pulmonary nodule
Anemia: non-megaloblastic causes of macrocytic anemia
HAND LAMP:
Hypothyroidism
Aplastic anaemia
Neonates
Drugs
Liver disease
Alcohol
Myelodyplasia
Pregnancy
Acromegaly symptoms
ABCDEF:
Arthralgia/ Arthritis
Blood pressure raised
Carpal tunnel syndrome
Diabetes
Enlargemed organs
Field defect
NSAIDs: contraindications NSAID:
Nursing and pregnancy
Serious bleeding
Allergy/ Asthma/ Angioedema
Impaired renal function
Drug (anticoagulant)
ACEI: contraindictions PARK:
Pregnancy
Allergy
Renal artery stenosis
K increase (hyperkalemia)
Pressure Sore: Norton Score MAGIC:
Mobility
ADL
General condition
Incontinence
Conscious level
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