By Dr. Anthony Policastro

Things tend to come in threes. For that reason, I will do one more article on mnemonics. I used to train Family Practice residents and medical students during their time on the pediatric rotation.

There were times when we had patients admitted with complex symptoms and an unclear diagnosis. I created a mnemonic to help approach making the diagnosis. The mnemonic was CITIMINT. I figured that Citibank needed a partner.

The letters stand for the 8 major categories of things that can produce an unusual group of symptoms in a pediatric patient. When you are not sure of a diagnosis, it produces a construct to look at things in a consistent manner.

The C stands for Congenital. There are many congenital conditions that can cause a wide variety of symptoms. There are congenital abnormalities that might show up later. An abnormally placed coronary artery is one of these. It can cause angina in a young person.

The first I is for infectious diseases. They are some of the most common causes of strange symptoms. For example I have seen tuberculosis present as blindness in one child and as quadriplegia in another. Diseases like syphilis, tuberculosis and infectious mononucleosis can cause a wide array of symptoms. The HIV virus is the newest one to fall into that same category.

The first T is for toxic. There are many types of poisons that can cause strange symptoms. When I was at Nanticoke Hospital, we had a patient with the strangest set of symptoms. We later found out that his wife was slowly giving him lead poisoning.

The next I is for inflammatory disorders. These include things like generalized rheumatoid arthritis. They include rheumatic fever. They include Lupus. They include the entire group of autoimmune disorders.

The M stands for metabolic. Some children have problems with specific areas of metabolism. The best known of these is cystic fibrosis. The most common is lactose intolerance.

The third I stands for Iatrogenic. That means doctor caused illnesses. The large group of medication side effects fall into this category.

The N stands for Neoplastic. In children the most common type of cancer is leukemia. It also produces the most varied group of symptoms. However, cancers of all types can act in strange ways. They produce a variety of symptoms.

The second T is for traumatic. There are sometimes traumatic injuries that produce later symptoms. The symptoms may occur long after the actual injury.

You might think that this is too complicated. However, I would like to end with one story about this method. When I was at Andrews AFB, we had a teenaged patient admitted. Her boyfriend had broken up with her earlier in the day. Her brother came home to find her in a catatonic state. She was just staring into space. This was an obvious psychiatric issue. We admitted her to the hospital. As an intellectual exercise we went through the CITIMINT mnemonic. Her intern took it to heart, he did an investigation based on the suggestions. One of the tests he ran was an EEG. The EEG showed that she was having a prolonged staring spell seizure. It was not psychiatric at all. We started seizure medication and “woke” her up.

Sometimes mnemonics actually make the process easier. The three I have covered over my last three articles are the ones that I made up. There are many more used in medicine. Sometimes they can be very beneficial.