Surgical sieve


The surgical sieve is a thought process in medicine. It is a typical example of how to organise a structured examination answer for medical students and physicians when they are challenged with a question. It is also a way of constructing answers to questions from patients and their relatives in a logical manner, and structuring articles and reference texts in medicine. Some textbooks put emphasis on using the surgical sieve as a basic structure of diagnosis and management of illnesses.

Overview

Although there are several versions around the world with slight variations, the surgical sieve usually consist of the following types of process in the human body in any particular order:
A more extensive, and perhaps more concise mechanism of employing the surgical sieve is using the mnemonic
MEDIC HAT PINE:
  • Metabolic
  • Endocrinological
  • Degenerative
  • Inflammatory/Infective
  • Congenital
  • Genetic / inherited
  • Haematological
  • Autoimmune
  • Traumatic
  • Psychological
  • Neurological
  • Idiopathic '''Iatrogenic
  • Neoplastic
  • Environmental'''

Examples

What are the causes of an acute confusional state in a patient?
  1. Treatment induced : polypharmacy, sedatives, analgesics, steroids, drug withdrawal
  2. Vascular: stroke, TIA, vascular dementia
  3. Inflammatory: infection, systemic inflammatory response syndrome
  4. Traumatic: head injury, Intracranial hemorrhage, shock
  5. Autoimmune: thyroid disease
  6. Metabolic: electrolyte imbalance, DKA, hypoglycaemia, SIADH
  7. Infective: sepsis, local infection
  8. Neoplastic: brain tumour, carcinomatosis
  9. Degenerative: Alzheimer's disease, dementia
What are the causes of splenomegaly?
  1. Idiopathic: Idiopathic thrombocytopenic purpura
  2. Vascular: portal vein obstruction, Budd-Chiari syndrome, haemoglobinopathies
  3. Infective: AIDS, mononucleosis, septicaemia, tuberculosis, brucellosis, malaria, infective endocarditis
  4. Traumatic: haematoma, rupture
  5. Autoimmune: rheumatoid arthritis, SLE
  6. Metabolic: Gaucher's disease, mucopolysaccharidoses, amyloidosis, Tangier disease
  7. Inflammatory: sarcoidosis
  8. Neoplastic: CML, metastases, myeloproliferative disorders

In popular culture

The surgical sieve is frequently used by Gregory House, who is a physician in the TV series House in order to diagnose the rare diseases his patients suffer from. In some episodes various forms of the surgical sieve are scribbled on to House's whiteboard while his team struggle to diagnose difficult cases. In the episode 'Paternity' the mnemonic 'MIDNIT' is used to run through the sieve.