The 5 Somatoform Disorders

The 5 Somatoform Disorders

1 Somatization Disorder
2 Conversion Disorder = Fxnal Neuro Sx Disorder (DSM-5)
3 Pain Disorder = Somatic Symptom Disorder, Pain Predominant (DSM-5)
4 Hypochondriasis = Illness Anxiety Disorder (DSM-5)
5 Body Dysmorphic Disorder

Somatization Disorder: 
To diagnose, you need 4 pain complaints (not necessarily the same as but can cover 2 GI complaints, 1 sex complaint, and 1 fake neuro complaint.

Conversion Disorder (Functional Neuro Symptoms Disorder in DSM-5):
To diagnose, you need unintentionally produced motor/sensory deficit, that can't be explained by cultural belief, medical condition, or drugs. Usually preceded by stress. If intentional, consider factitious disorder (1* gain: PAY ATTENTION TO ME!), or malingering (2* gain: $$$$, time off work).

Pain Disorder
To diagnose, you need somatic symptoms associated with significant distress and impairment with no physical cause.

Illness Anxiety Disorder
To diagnose, you need disease preoccupation and conviction despite medical reassurance that there is no problem.

Body Dysmorphic Disorder
Excessive preoccupation with a supposed physical defect and its effect on the patient's appearance.

Loss of Consciousness Disorders

Loss of Consciousness Disorders:

Narcolepsy: Disorder of unknown origin where patient cannot resist falling asleep, usually for 20 minutes. Patient may not be able to move on arousal, representing a frightening intrusion of REM sleep phenomena into consciousness. My also involve

Cataplexy: Loss of limb control, and limb paralysis when experiencing a strong emotion, where consciousness is preserved.

not to be confused with Catalepsy: a trance or seizure with a loss of sensation and consciousness accompanied by rigidity of the body.

MMC medical podcast

Wow, mmc medical podcast for USMLE and COMLEX 1 is awesome.
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Shock etc.
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Discharge Summary Outline

Name
Identification information 
Primary care practitioner
Date of admission
Discharge information regarding course of treatment
Primary diagnosis (es)
Secondary diagnosis (es) 
Consultation, 
Brief HPI 
Hospital course by problem (make sure all diagnoses are addressed)
Physical examination
Medications (with dose, freq, route of adm, duration and purpose)
Disposition (how is the patient now?)
Discharge instructions

Thrombocytopenia Algorithm

The Nuclei of the Thalamus

LGN: Lateral Geniculate Nucleus = "The Looking Geniculate Nucleus" responsible for sight

LVP: Lateral Ventral  Posterior Nucleus = "Like Veeling People" responsible for body touch

MGN: Medial Geniculate Nucleus = "Music Geniculate Nucleus"responsible for sound

MVP: Medial Ventral Posterior Nucleus = "My Visage is Prickly" responsible for facial feeling

VA: Ventral Anterior Nucleus = "Veering Away" responsible for body motion

Mini Mental Status Exam

The BEERS Criteria Sheets

Mnemonics for Personality Disorders

Cluster A: "He wore a Weird Pair of Short Shorts." Paranoid, Schizoid, Schizotypal. Tend to Schizo disorder.

Cluster B: "So a Wild Boar Ate His Nuts." Borderline, Antisocial, Histrionic, Narcissistic. Tend to Mood disorders.

Cluster C: "Worried, he Avoids Depending on Others." Avoidant, Dependant, OCPD (Not OCD). Tend to anxiety disorders.

How to Remember the MEN Syndromes

MEN1: Lots of "P"s and Zollinger ElliSON. (Say it this way to emphasize the rhyme) (Pituitary, Prolactinoma, Pancreatic and Zolinger Ellson Syndrome, explained below).

MEN2A: Tee Pee Phay (Thyroid, Parathyroid and Pheochromocytoma Neoplasias)

MEN2B: Tee Phay Gee (Thyroid, Pheochromocytoma, Ganglioneuroma Neoplasias)

Using this mnemonic, keep straight the Multiple Endocrine Neoplasia Syndromes and the major Organs they affect. There's also a figure most people use with a triangle or something, but I always found that confusing so I won't bother with it. Rhymes are easier for my mind at least. 

In detail, the syndromes per an amalgam of online resources:

Multiple endocrine neoplasia type 1 (MEN-1 syndrome) aka Wermer's syndrome is characterized by the following disorders:

• Overactivity of the Parathyroid gland (hyperparathyroidism) is the most common sign of this disorder. Hyperparathyroidism disrupts the normal balance of calcium in the blood, which can lead to kidney stones, thinning of the bones (osteoporosis), high blood pressure (hypertension), loss of appetite, nausea, weakness, fatigue, and depression.
• Neoplasia in the Pituitary gland can manifest as Prolactinomas whereby too much prolactin is secreted, suppressing the release of gonadotropins, causing a decrease in sex hormones such as testosterone. Pituitary tumor in MEN1 can be large and cause signs by compressing adjacent tissues.
• Pancreatic tumors associated with MEN-1 usually form in the beta cells of the islets of Langerhans, causing over-secretion of insulin, resulting in low blood glucose levels (hypoglycemia). However, many other tumors of the pancreatic Islets of Langerhans can occur in MEN-1. One of these, involving the alpha cells, causes over-secretion of glucagon, resulting in a classic triad of high blood glucose levels (hyperglycemia), a rash called necrolytic migratory erythema, and weight loss. 
• Another is a tumor of the non-beta islet cells, known as a gastrinoma, which causes the over-secretion of the hormone gastrin, resulting in the over-production of acid by the acid-producing cells of the stomach (parietal cells) and a constellation of sequelae known as Zollinger-Ellison syndrome. Zollinger-Ellison syndrome may include severe gastric ulcers, abdominal pain, loss of appetite, chronic diarrhea, malnutrition, and subsequent weight loss.

There are three subtypes of MEN 2: Familial Medullary Thyroid Cancer (FMTC), MEN 2A, and MEN 2B. ll are due to an autosomal dominant ret mutation.

Familial Medullary Thyroid Cancer (FMTC): 

In this form of MEN 2, patients present with only medullary thyroid carcinoma. (not covered by my mnemonic.)

Multiple endocrine neoplasia, type 2A (MEN 2A), aka Sipple Syndrome, is a hereditary syndrome characterized by
medullary carcinoma of the Thyroid,
hyperParathyroidism, 

pheochromocytoma,
and occasionally cutaneous lichen amyloidosis.


MEN 2B may have:
Medullary Thyroid cancer
Pheochromocytoma (generally benign tumor in the adrenal glands)
Mucosal Ganglioneuroma (benign tumor of nerve tissue on the tongue and lips)
Digestive problems
Muscle, joint, and spinal problems
Certain facial features typical of MEN 2B also include swollen lips and thick eyelids

EKG Leads and Where They Go

Acute Renal Failure Algorithm

Acute Kidney Injury

The Five Axes of Psychiatric Diagnosis in DSM-IV

In DSM-IV, clinical disorders are listed on 5 separate axes as described below (NOTE that, in DSM-5, all of these are listed on a single axis).

Axis I refers broadly to the principal disorder that needs immediate attention; for example, a major depressive episode, an exacerbation of schizophrenia, or a flare-up of panic disorder. It is usually (though not always) the Axis I disorder that brings the person "through the office door."

Axis II lists any personality disorder that may be shaping the current response to the Axis I problem. Axis II also indicates any developmental disorders, such as mental retardation or a learning disability, which may be predisposing the person to the Axis I problem. For example, someone with severe mental retardation or a paranoid personality disorder may be more likely to be "bowled over" by a major life stressor, and succumb to a major depressive episode.

Axis III lists any medical or neurological problems that may be relevant to the individual's current or past psychiatric problems; for example, someone with severe asthma may experience respiratory symptoms that are easily confused with a panic attack, or indeed, which may precipitate a panic attack.

Axis IV codes the major psychosocial stressors the individual has faced recently; e.g., recent divorce, death of spouse, job loss, etc.

Axis V codes the "level of function" the individual has attained at the time of assessment, and, in some cases, is used to indicate the highest level of function in the past year. This is coded on a 0-100 scale, with 100 being nearly "perfect" functioning (none of us would score that high!).  SEE TABLE BELOW…

Summary of Global Assessment of Functioning (GAF) Scale (DSM–IV)

Code	Description of Functioning
91 - 100	Person has no problems OR has superior functioning in several areas OR is admired and sought after by others due to positive qualities
81 - 90	Person has few or no symptoms. Good functioning in several areas. No more than "everyday" problems or concerns.
71 - 80	Person has symptoms/problems, but they are temporary, expectable reactions to stressors. There is no more than slight impairment in any area of psychological functioning.
61 - 70	Mild symptoms in one area OR difficulty in one of the following: social, occupational, or school functioning. BUT, the person is generally functioning pretty well and has some meaningful interpersonal relationships.
51 - 60	Moderate symptoms OR moderate difficulty in one of the following: social, occupational, or school functioning.
41 - 50	Serious symptoms OR serious impairment in one of the following: social, occupational, or school functioning.
31 - 40	Some impairment in reality testing OR impairment in speech and communication OR serious impairment in several of the following: occupational or school functioning, interpersonal relationships, judgment, thinking, or mood.
21 - 30	Presence of hallucinations or delusions which influence behavior OR serious impairment in ability to communicate with others OR serious impairment in judgment OR inability to function in almost all areas.
11 - 20	There is some danger of harm to self or others OR occasional failure to maintain personal hygiene OR the person is virtually unable to communicate with others due to being incoherent or mute.
1 - 10	Persistent danger of harming self or others OR persistent inability to maintain personal hygiene OR person has made a serious attempt at suicide.