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Methemoglobinemia Treatment Mnemonic

Methemoglobinemia is an important Emergency Medicine topic to know for the boards. You may see the clues of recent anesthetic or nitrate use and chocolate colored blood.

This mnemonic is very simple and will help you remember the treatment.

Treat METHemoglobinemia with METHylene blue!

Source: Fischer, Conrad, and Sonia Reichert. "Emergency Medicine/Toxicology." USMLE Step 3: Master the Boards. New York, NY: Kaplan, 2009. 497. Print.

Heberden's and Bouchard's Nodes Mnemonic

Heberden’s and Bouchard’s nodes both refer to bony prominences located in the finger joints. However, they are both in different locations and are both tested differently on the boards.

Heberden’s nodes are present in the distal interphalangeal (DIP) joints, while Bouchard’s nodes are present in the proximal interphalangeal (PIP) joints.

Both Heberden’s and Bouchard’s nodes can be found in osteoarthritis. However, the presence of Bouchard’s nodes (with the absence of Heberden’s nodes) on a board question can help you in diagnosing Rheumatoid Arthritis.

This mnemonic will help you to remember the location of these nodes. If you see Heberden’s nodes think of osteoarthritis, and if you see Bouchard’s nodes think of rheumatoid arthritis.

Heberden’s nodes are Higher up on the finger.

Bouchard’s nodes are closer to the Body.

Sources:

Bickley, Lynn S., Peter G. Szilagyi, and Barbara Bates. "The Musculoskeletal System." Bates' Pocket Guide to Physical Examination and History Taking. 6th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009. 284. Print.

Poinier, Anne C., and Stanford M. Shoor. "Heberden's and Bouchard's Nodes." Arthritis Health Center. WebMd, 8 Apr. 2011. Web. 16 Sept. 2012. <http://arthritis.webmd.com/heberdens-and-bouchards-nodes>.

TIMI Risk Score for UA/NSTEMI Mnemonic

The Thrombolysis In Myocardial Infarction (TIMI) Score is used to estimate the risk of death, risk of MI, or need for urgent cardiac catheterization in patients with Unstable Angina (UA) or Non-ST segment Elevation Myocardial Infarction (NSTEMI). Each risk factor is worth one point, for a max score of 7. The higher the score, the greater likelihood that one of the above events will occur. This score can help guide decision making, mostly to determine if the patient will need a cardiac catheterization or other method of ruling out cardiac ischemia.

A good way to remember the components of the TIMI Score for UA/NSTEMI is with the mnemonic ABCDE.

A Age, Aspirin, Angina 

B Biomarker

C CAD risk factors

D Diagnosis of CAD

E EKG changes

The exact criteria are listed below:

Age ≥ 65, Aspirin use in past 7 days, Severe Angina (≥ 2 episodes within 24 hours)
Positive cardiac Biomarker (troponin, CKMB)

≥ 3 Risk Factors for CAD

Diagnosis of CAD (stenosis ≥ 50%) in the past

ST changes ≥ 0.5mm on EKG

Sources:

"Mdcalc.com | TIMI Risk Score for UA/NSTEMI." Mdcalc.com | TIMI Risk Score for UA/NSTEMI. Web. 09 Aug. 2012. <http://www.mdcalc.com/timi-risk-score-for-uanstemi/>.

"TIMI Study Group." TIMI Study Group. Web. 09 Aug. 2012. <http://www.timi.org/>.

Charcot’s Triad Mnemonic

The components of Charcot’s triad are very high yield on the boards and are important to know on hospital rotations as well. In order to remember what the three signs/symptoms are and what they help to diagnose, all you need to look at are the first three letters!

ChArcot’s Triad is for Ascending Cholangitis.

CHArcot’s Triad consists of:

Color (Jaundice)

Hyperthermia (Fever)

Abdominal pain (Right upper quadrant)

Also, don’t forget about Reynolds’ Pentad which adds Shock and Altered Mental Status to Charcot’s Triad.

Source:

Shojamanesh, Homayoun. "Cholangitis." EMedicine. Ed. Julian Katz. Medscape, 5 Jan. 2012. Web. 22 July 2012. <http://emedicine.medscape.com/article/184043-overview>.

How to Write a SOAP Note or Progress Note

A SOAP Note, aka Progress Note is the daily record of a patient’s time in the hospital. SOAP is a mnemonic to remember the different components of this note. It stands for Subjective, Objective, Assessment, and Plan.

The Subjective section is for everything the patient tells you, the Objective section is for documenting your findings and data, the Assessment section is for a list of the patient’s issues being addressed, and the Plan section is for what you are doing about the items in the assessment. Many times the assessment and plan sections are combined.

SAOP notes are written daily starting on hospital day 2, since on the first day a History and Physical will be completed. A sample template is found below.

Important things to remember:

·        The date, time, and signature should always be included.

·        A medication list fits very well in the margin. Be sure to include IV fluids, and for antibiotics, how many days the patient has been on each one.

·        Put what service you are on and what attending you are following at the top.

·        Labs can be written in the shorthand format shown in the sample note.

·        Be sure to include Vital Signs, Is and Os, any new radiological data, EGK and telemetry strips.

·        For more assessment/plan items you can always include DVT and GI prophylaxis (such as SCDs or acid suppression drugs), Disposition (when you think the patient will be discharged), and Code Status (such as Full, DNR, etc.).

Reminder: Special Direct Consolidation Loans End June 30, 2012

Just a reminder to all recent medical school graduates that the deadline to apply for the Special Direct Consolidation Loan is June 30, 2012. If you haven’t applied already, it’s not too late. I think if you can take advantage of this opportunity, you should.

If you are eligible you should have received an email from the Department of Education and/or your loan servicer. Don’t ignore it! If you haven’t received an email informing you of your eligibility, the easiest way to check is to login to StudentLoans.gov. If you are eligible there will be a message stating so on the top right of the page. You can also apply for the loan from this page as well.

If you want to check for yourself if you are eligible then login to the National Student Loan Data System (NSLDS) (I’ve mentioned this site before) and look at the detail of each loan. The requirements and full information for the Special Direct Consolidation Loan can be found on the Department of Education website here, but I’ll try to simplify it.

The point of any consolidation loan is to combine several loans (at least more than one) into only one loan to simplify your payments. I am not a fan of the Traditional Direct Consolidation Loan because it increases your repayment term and also averages your interest rate, so you will end up paying a lot more than if you just kept them separate. I can see this loan possibly being useful if every individual loan you had was serviced by someone different and you would have to send in many different checks, but even then it would just take a few minutes to set up an automatic withdrawal from your checking for each one.

Anyway, the Special Direct Consolidation Loan does not have any of these downsides. It does not increase the repayment term and it keeps the same interest rate for each loan that was consolidated. Also as a BONUS you get a 0.25% interest rate reduction on EACH loan that was consolidated, just for consolidating! I don’t see any reason not to do this.

So, if you are checking your loans yourself to see if you are eligible you need to have two things:

First, you need to have a student loan owned by the Department of Education and serviced by a Department servicer. Most people have this. It will tell you who owns and services the loan on the loan detail page on the NSLDS. (Click on the number to the left of the loan in the list to get to the individual detail page.)

Second, you need to have a commercially-owned (not owned by the Dept. of Ed.) FFEL loan that is serviced by that lender or some other commercial servicer that lender hired. FFEL stands for “Federal Family Education Loan” which is just the fancy heading that Stafford (subsidized and unsubsidized) and PLUS (grad and parent) loans fall under. So basically you need a Stafford or PLUS loan not owned by the government. You can tell this from the NSLDS detail page because it won’t say Dept. of Ed. anywhere for that loan.

Which loans you have and who owns and services each loan will be different for everybody. Your loans probably got sold at least once during medical school and may be owned by someone different than when you first took it out. If it ended up that all of your loans were owned by the Department of Education when you graduated, then you won’t be eligible. However, if you have any undergraduate loans still owned by a commercial lender, you should be eligible and can benefit from this. But hurry! The deadline is approaching.

Source:

http://studentaid.ed.gov/PORTALSWebApp/students/english/specialconsolidation.jsp