Every medical student learns the differential diagnosis for an anion gap metabolic acidosis. The list is particularly crucial for emergency physicians, who often see this finding in sick, undifferentiated patients. Many people use the mnemonics “MUDPILES CAT” or “GOLDMARK” to help remember this list. An alternative mnemonic, “KULT IMPACT”, provides a practical and organized way of remembering the differential. “KULT” denotes the most common organic causes: Ketones: diabetic ketoacidosis (DKA), alcoholic ketoacidosis, starvation …
Tiny Tips: ICH for ICH – Brain Herniation
Brain herniation is a catastrophic sequela of increased intracranial pressure (ICP) or local mass effect from intracranial lesions. Different types of brain herniation can occur depending on the location of mass effect and how rapidly this mass effect develops.1 Any mass lesion, including hemorrhage, tumor, vasogenic or cytotoxic edema, trauma or infection can cause herniation. However spontaneous intracerebral hemorrhage (ICH) and traumatic brain injury (TBI) are common causes of herniation in the acute …
Tiny Tips: “TREADMILLS” Peripheral Neuropathy mnemonic
Peripheral neuropathy is prevalent in up to 2.4% of the general population1. It is often characterized by an asymmetric distribution with sensory symptoms following a dermatomal pattern. Initial investigations include a complete blood count (CBC), metabolic panel (electrolytes, glucose, urea, creatinine), and thyroid stimulating hormone (TSH)2. There are many causes for peripheral neuropathy, so when considering the etiology, think “TREADMILLS.” Toxins Ethanol, Heavy metals, Tetanus, Organophosphates, Diphtheria Renal Failure Endocrine Diabetes, Hypothyroidism Acquired …
Tiny Tips: “C-3PO’s RIVAL” Acute Unilateral Painless Vision Loss mnemonic
Early diagnosis and treatment of acute, painless vision loss greatly increases the chances of vision restoration. Though treatment for most conditions involves an ophthalmology consult, it is important to consider and evaluate for the possible etiologies. A mnemonic to remember the list of causes for acute unilateral painless vision loss is “C-3PO’s RIVAL”.1 Central Retinal Artery Occlusion (CRAO) Central Retinal Vein Occlusion (CRVO) Cerebral Vascular Accident (CVA) Posterior Vitreous Detachment (PVD) Optic Neuritis …
The Use of the Modified Valsalva Maneuver for Stable SVT
Please note that, while “supraventricular tachycardia (SVT)” is a term that can be used more broadly to refer to any tachyarrhythmia originating above the ventricles, I use its more conventional meaning here to describe AVnRT and AVRT. LITFL has a good summary of narrow-complex tachycardias. SVT is a narrow complex tachycardia commonly seen in the emergency department. In hemodynamically stable patients the first-line treatment is vagal stimulation, usually the Valsalva maneuver. However, success …
Tiny Tips: “SNOOP MEETS Pregnancy” Headache mnemonic
Many must-not-miss diagnoses manifest as a secondary headache. Though the DDx list is quite large, the pertinent questions that must be asked on history can be remembered using the mnemonic “SNOOP MEETS Pregnancy”1,2 Below you’ll find the cues associated with each letter, the symptoms they are associated with, and the differential diagnosis for some of those symptoms. Systemic symptoms = fever, night sweats, weight loss, loss of appetite, protracted vomiting DDx: Meningitis, Encephalitis, Systemic infection, Lyme …