vindicate mnemonic
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VINDICATE Mnemonic: Why it is Crucial for Your Success

Introduction

The Vindicate mnemonic is a systematic approach to coming up with a broad differential diagnosis.

Coming up with a differential diagnosis is the process of coming up with all of the possible causes that could be causing a patients symptoms.

Starting out in medical school can be tough, but honestly something that can be even tougher is when you get a year or 18 months into medical school and you start to build some decent knowledge.

The 3rd and 4th years of medical school are all about helping you build a larger differential diagnosis and expanding that knowledge. Using an approach like the vindicate mnemonic can be very helpful in coming up with all of the possibilities for a diagnosis.

Then, after you come up with a long and broad list of possible diagnosis’s, you need to narrow it down. That’s where testing and sometimes treating to see if it gets better comes into play.

For now, lets focus on using mnemonics to come up with a large differential to make you look like a genius!

What is the VINDICATE Mnemonic

This is a simple and effective way to remember other systems and guide other thoughts on developing your differential diagnosis.

There are multiple ways to develop a differential diagnosis. One of the top ways is a systems approach, and the vindicate mnemonic uses systems in a way to help you remember other causes.

It can be tough when you are presented with a patient that is complaining of chest pain for example. What could the diagnosis be if it isn’t related to the heart?

That is where something like this mnemonic comes into play, and I can assure you it has made the difference in my OSCE’s and during other patient encounters, and is actually encouraged by the NBOME.

Why it is useful to have these for Medical School and practice

It is so easy to forget what we have learned, and it is even easier to get so focused on one or two possible diagnosis’s that you stop thinking about other possible causes, but a broader and larger differential is always a good idea.

That is where the vindicate mnemonic and other techniques come into play.

For each of the parts of the mnemonic, we will go over some examples for our patient that is complaining of chest pain. This is not an exhaustive list by any means, but it can give you an idea how to use this.

Vascular

  • Consider all possible causes that include the vascular system
  • Ex: MI, anueysm, dissection, PE, pulmonary HTN
  • While not an exhaustive list, it gives you a good idea of what to think of when considering the vascular causes.

Infectious

  • Pneumonia, endocarditis, esophagitis, bronchitis, URI
  • You get the point with the exhaustive list right?

Neoplastic

  • Cardiac/Pulmonary cancers, esophageal cancer, liver cancer, thyroid diseases

Degenerative

  • Costochondritis, tendinitis, GERD, any MSK complaint

Intoxication/Iatrogenic

  • Ingestion, perforation during procedure, CO poisoning, Pneumothorax from procedure

Congenital

  • Any congenital disease related to the cardiopulmonary system that hasn’t been diagnosed already, or those that have.

Autoimmune

  • Lupus, RA, Vasculitis (also vascular), pneumonitis

Traumatic

  • Rupture of aortic arch, fractures, bruising, need to consider all possible outcomes from trauma.

Endocrine/Metabolic:

  • Thyroid issues, adrenal gland insufficiency

Other ways to Create a broad Differential Diagnosis

Other mnemonics like Vitamins, or a systems approach like going through each pathological system you can think of, then an easier way that is very straightforward is the anatomical way.

The anatomical way is thinking about all the different anatomy parts in the region the patient is complaining of, you can just start with the skin and go through the body.

For chest pain: shingles, costochondritis, MI, pulmonary embolism/pneumonia, aortic arch aneurysm/dissection, CNS tumor, pneumonitis, and then muscles and bone on the back.

That is a super simple way to think of all the parts that could be causing issues, and one that you don’t have to memorize anything for.

Vindicate mnemonic

Final thoughts on Mnemonics like this one

Mnemonics make the world go round in medical school, they can take a complicated topic and make it possible for you to remember it.

The vindicate mnemonic is a little bit different though, it isn’t helping you remember any one thing in particular. This is really a way for you to remember all those other things you know at times when you need to remember them.

I am a huge fan of mnemonics similar to this one, simply because it can be so hard to organize and remember all the things we have learned, and this helps you accomplish it.

Not to mention, it also makes you look like a star on the wards when you can come up with a broad differential on a complicated patient.

Related FAQ’s

How do you write a good differential diagnosis?

There are key things you need to know in order to write a good differential diagnosis.

You need to know your symptoms, duration of illness, pathologies, and really you just gotta know the disease’s inside and out.

Then, you come up with a systematic way like the above mnemonic lays out and you will be well on your way to develioping a good differential diagnosis.

What is an illness script?

An illness script is basically how a disease presents and what the signs and symptoms are. Each disease has a specific set of signs and symptoms, and there are a lot of them that overlap, but typically each one will have defining features.

Another way to think of it is that the illness script is your wealth of knowledge.

What is diagnostic framework?

This is another word for the illness script above. It is all the information that you need to make a diagnosis.

What is a do not miss diagnosis?

These are the things that you absolutely do not want to miss, because they can lead to some serious issues with the patient. I once had a preceptor that called these the “nasties”. He always said tht we had to make sure we always ruled out the nasties when it came to our patients.

Make sure you rule out the things that can really cause harm or kill your patients.

I really hope this has been helpful to you

Be sure to check out some of the other articles that are similar below

Thanks for reading

Sean Kiesel, DO, MBA

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