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Abel
The Truth To Commonly Held Myths About End-of-life Issues And Hospice Care
~1.5 mins read
Some people don’t have a health care power of attorney or living will because they don’t realize how important these documents are. Others worry that such documents mean they are signing their lives away. Not so.
These powerful documents make sure that you get the treatment you would want for yourself if you couldn’t communicate your wishes. Here are a few myths that shouldn’t get in the way of creating a health care power of attorney or living will:
Myth: More care is always better.
Truth: Not necessarily. Sometimes more care prolongs the dying process without respect for quality of life or comfort. It’s important to know what interventions are truly important. It’s often impossible to know that in advance. That’s where the advice of a healthcare team is invaluable.
Myth: Refusing life support invalidates your life insurance, because you are committing suicide.
Truth: Refusing life support does not mean that you are committing suicide. Instead, the underlying medical problem is considered to be the cause of death.
Myth: If medical treatment is started, it cannot be stopped.
Truth: Not starting a medical treatment and stopping a treatment are the same in the eyes of the law. So you or your health care agent can approve a treatment for a trial period that you think may be helpful without fear that you can’t change your mind later. However, be aware that stopping treatment can be more emotionally difficult than not starting it in the first place.
Myth: If you refuse life-extending treatments, you’re refusing all treatments.
Truth: No matter what treatments you refuse, you should still expect to receive any other care you need or want — especially the pain and symptom management sometimes called intensive comfort care.
Myth: Stopping or refusing artificial nutrition and hydration causes pain for someone who is dying.
Truth: Unlike keeping food or water from a healthy person, for someone who is dying, declining artificial nutrition or intravenous hydration does not cause pain.
These powerful documents make sure that you get the treatment you would want for yourself if you couldn’t communicate your wishes. Here are a few myths that shouldn’t get in the way of creating a health care power of attorney or living will:
Myth: More care is always better.
Truth: Not necessarily. Sometimes more care prolongs the dying process without respect for quality of life or comfort. It’s important to know what interventions are truly important. It’s often impossible to know that in advance. That’s where the advice of a healthcare team is invaluable.
Myth: Refusing life support invalidates your life insurance, because you are committing suicide.
Truth: Refusing life support does not mean that you are committing suicide. Instead, the underlying medical problem is considered to be the cause of death.
Myth: If medical treatment is started, it cannot be stopped.
Truth: Not starting a medical treatment and stopping a treatment are the same in the eyes of the law. So you or your health care agent can approve a treatment for a trial period that you think may be helpful without fear that you can’t change your mind later. However, be aware that stopping treatment can be more emotionally difficult than not starting it in the first place.
Myth: If you refuse life-extending treatments, you’re refusing all treatments.
Truth: No matter what treatments you refuse, you should still expect to receive any other care you need or want — especially the pain and symptom management sometimes called intensive comfort care.
Myth: Stopping or refusing artificial nutrition and hydration causes pain for someone who is dying.
Truth: Unlike keeping food or water from a healthy person, for someone who is dying, declining artificial nutrition or intravenous hydration does not cause pain.
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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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