This is a list of mnemonics used in medicine and medical science, categorized and alphabetized. A mnemonic is any technique that assists the human memory with information retention or retrieval by making abstract or impersonal information more accessible and meaningful, and therefore easier to remember; many of them are acronyms or initialisms which reduce a lengthy set of terms to a single, easy-to-remember word or phrase.
Mnemonics with wikipages
ABC — airway, breathing, and circulation AEIOU-TIPS — causes of altered mental status APGAR — a backronym for appearance, pulse, grimace, activity, respiration (used to assess newborn babies) ASHICE — age, sex, history, injuries/illness, condition, ETA/extra information FAST — face, arms, speech, time (stroke symptoms) Hs and Ts — causes of cardiac arrest IS PATH WARM? — suicide risk factors OPQRST — onset, provocation, quality, region, severity, time (symptom checklist often used by first responders) RICE — rest, ice, compression, elevation (generic treatment strategy for sprains and bruises) RNCHAMPS — types of shock RPM-30-2-Can Do — START triage criteria SOCRATES — used to evaluate characteristics of pain SOAP – a technique for writing medical records SLUDGE — salivation, lacrimation, urination, defecation, gastric upset, and emesis (effects of nerve agent or organophosphate poisoning)
Anatomy
Anaesthesiology
Anaesthesia machine/room check MS MAID:
Monitors (EKG, SpO2, EtCO2, etc.) Suction Machine check (according to ASA guidelines) Airway equipment (ETT, laryngoscope, oral/nasal airway) IV equipment Drugs (emergency, inductions, NMBs, etc.)
Endotracheal intubation: diagnosis of poor bilateral breath sounds after intubation DOPE:
Displaced (usually right mainstem, pyriform fossa, etc.) Obstruction (kinked or bitten tube, mucous plug, etc.) Pneumothorax (collapsed lung) Esophagus
General anaesthesia: equipment check prior to inducing MALES:
Masks Airways Laryngoscopes Endotracheal tubes Suction/Stylette, bougie
Spinal anaesthesia agents "Little Boys Prefer Toys":
Lidocaine Bupivacaine Procaine Tetracaine
Xylocaine: where not to use with epinephrine "Ears, nose, hose, fingers, and toes"
The vasoconstrictive effects of xylocaine with epinephrine are helpful in providing hemostasis while suturing; however, they may also cause local ischemic necrosis in distal structures such as the digits, tip of nose, penis, ears, etc. "Digital PEN" – digits, penis, ear, nose
Behavioral science/psychology
Depression: major episode characteristics SPACE DIGS:
Sleep disruption Psychomotor retardation Appetite change Concentration loss Energy loss Depressed mood Interest wanes Guilt Suicidal tendencies
Depression: DSM-V criteria for major depressive disorder "SIG E CAPS":
Sleep disturbances Interest decreased (anhedonia) Guilt and/or feelings of worthlessness Energy decreased Concentration problems Appetite/weight changes Psychomotor agitation or retardation Suicidal ideation
Gain: primary vs. secondary vs. tertiary Primary: patient's psyche improved Secondary: symptom sympathy for patient Tertiary: therapist's gain
Kubler-Ross dying process: stages "Death always brings great acceptance":
Denial Anger Bargaining Grieving Acceptance
Middle adolescence (14–17 years): characteristics HERO:
Heterosexual/Homosexual crushes Education regarding short-term benefits Risk-taking Omnipotence
Narcolepsy: symptoms, epidemiology CHAP:
Cataplexy Hallucinations Attacks of sleep Paralysis on waking Usual presentation is a young male, hence "chap"
Suicide: risk screening SAD PERSONS scale:
Sex (male – completion, female – attempt) Age (adolescent or elderly) Depression Previous attempt Ethanol abuse Rational thinking loss Social support problems Organised plan No spouse Sickness (chronic illness)
Sleep stages: features Delta waves during Deepest sleep (stages 3 and 4, slow-wave) dREaM during REM sleep
Impotence causes PLANE:
Psychogenic: performance anxiety Libido: decreased with androgen deficiency, drugs Autonomic neuropathy: impede blood flow redirection Nitric oxide deficiency: impaired synthesis, decreased blood pressure Erectile reserve: cannot maintain an erection
Male erectile dysfunction (MED): biological causes MED:
Medicines (propranolol, methyldopa, SSRIs, etc.) Ethanol Diabetes mellitus
Premature ejaculation: treatment 2 S's:
SSRIs Squeezing technique (glans pressure before climax) More detail with 2 more S's:
Sensate-focus exercises (relieves anxiety) Stop and start method (5–6 rehearsals of stopping stimulation before climax)
Biochemistry
B vitamin names "The rhythm nearly proved contagious": In increasing order:
Thiamine (vitamin B1, also spelled thiamin) Riboflavin (vitamin B2) Niacin (vitamin B3, also called nicotinic acid) Pyridoxine (vitamin B6) Cobalamin (vitamin B12)
Essential amino acids "TIM HALL PVT. (Ltd.) always argue and never (get) tire":
Phe – phenylalanine Val – valine Thr – threonine Trp – tryptophan Ile – isoleucine Met – methionine His – histidine Arg – arginine Leu – leucine Lys – lysine Always argue: A is for Arg (Arginine) not Asp (Aspartic acid). 'Never tire': T is not Tyr (Tyrosine), but is both Thr (Theronine) and Trp (Tryptophan). †Note that this initialism uses single letters for each amino acid that are not the same as the standard single-letter codes commonly used in molecular biology to uniquely specify each amino acid; for example, though phenylalanine is represented here by the letter "P", it is formally represented by the letter "F" in most other contexts, and "P" is instead used to formally represent proline.
Fasting state: branched-chain amino acids used by skeletal muscles "Muscles LIVe fast":
Leucine Isoleucine Valine
Fat-soluble vitamins "The fat (fat-soluble vitamins) cat lives in the ADEK (vitamins A, D, E, and K) Or as fat soluble - ADEK = "All Dads Eat Kids" ."
Folate deficiency: causes A FOLIC DROP:
Alcoholism Folic acid antagonists Oral contraceptives Low dietary intake Infection with Giardia Celiac sprue Dilantin Relative folate deficiency Old Pregnant
Glycogen storage: Anderson's (IV) vs. Cori's (III) enzyme defect ABCD:
Anderson's = Branching enzyme Cori's = Debranching enzyme Otherwise, cannot really distinguish clinically.
Glycogen storage: names of types I through VI "Viagra pills cause a major hardon tendency":
Von Gierke's Pompe's Cori's Anderson's McArdle's Her's Tarui's
Enzyme classes "'On The Hill, LIL' Transformers":
1 - Oxidoreductases 2 - Transferases 3 - Hydrolases 4 - Lyases 5 - Isomerases 6 - Ligases 7 - Translocases
Cardiology
Critical care / intensive care
Daily patient checks: FAST-HUGS FAST-HUGS is a mnemonic in critical care to ensure that essential aspects of patient management are reviewed daily.
F — Feeding (nutritional support) A — Analgesia (pain control) S — Sedation (appropriate sedation levels) T — Thromboprophylaxis (prevention of venous thromboembolism) H — Head up (elevate the head of bed to reduce aspiration risk) U — Ulcer prophylaxis (prevent stress-related mucosal damage) G — Glucose control (maintain adequate blood glucose levels) S — Spontaneous breathing trial (assess readiness for ventilator weaning)
Vital signs: THROB-C THROB-C is a mnemonic for vital signs in intensive care:
T — Temperature H — Heart rate R — Respiratory rate O — Oxygen saturation B — Blood pressure C — Consciousness
Emergency medicine
Acute LVF management LMNOP:
Lasix (furosemide) Morphine (diamorphine) Nitrates Oxygen (sit patient up) Pulmonary ventilation (if doing badly)
Atrial fibrillation: causes of new onset THE ATRIAL FIBS:
Thyroid Hypothermia Embolism (P.E.) Alcohol Trauma (cardiac contusion) Recent surgery (post CABG) Ischemia Atrial enlargement Lone or idiopathic Fever, anemia, high-output states Infarct Bad valves (mitral stenosis) Stimulants (cocaine, theo, amphet, caffeine)
Well's criteria Secret little TIP (about) blood clots: Signs/symptoms of PE (3) PE is the most likely diagnosis (3) Tachycardia >100bpm (1.5) Iimmobilisation/surgery in the last 4 weeks (1.5) Previous DVT/PE Blood in sputum (haemoptysis) (1) Active cancer (1) Two tier score: PE likely > 4
Causes of life-threatening chest pain PET-MAC
P = Pulmonary embolism E = Esophageal rupture T = Tension pneumothorax M = Myocardial infarction A = Aortic dissection C = Cardiac tamponade
GCS intubation Under 8, intubate.
Ipecac: contraindications 4 C's:
Comatose Convulsing Corrosive hydrocarbon
JVP: raised JVP differential PQRST(EKG waves):
Pericardial effusion Quantity of fluid raised (fluid over load) Right heart failure Superior vena caval obstruction Tricuspid stenosis/tricuspid regurgitation/tamponade (cardiac)
MI: immediate treatment DOGASH:
Diamorphine Oxygen GTN spray Aspirin 300 mg Streptokinase Heparin
PEA/asystole (ACLS): cause ITCHPAD Infarction Tension pneumothorax Cardiac tamponade Hypovolemia/hypothermia/hypo-,hyperkalemia/hypomagnesmia/hypoxemia Pulmonary embolism Acidosis Drug overdose
Rapid sequence intubation (RSI) SOAP ME Suction Oxygen Airway equipment Positioning Monitoring & medications EtCO2 & other equipment Rapid sequence intubation medications (RSI) (CCRx) Very calmly engage the respiratory system Vecuronium 0.1 mg/kg Cisatracurium 0.2 mg/kg Etomidate 0.3 mg/kg Rocuronium 0.6 mg/kg-1.2 mg/kg Succinylcholine 1 mg/kg
Shock: signs and symptoms TV SPARC CUBE: Thirst Vomitting Sweating Pulse weak Anxious Respirations shallow/rapid Cool Cyanotic Unconscious BP low Eyes blank
Shock: types RN CHAMPS (Alternatively: "MR. C.H. SNAP", or "NH CRAMPS"): Respiratory Neurogenic Cardiogenic Hemorrhagic Anaphylactic Metabolic Psychogenic Septic
Subarachnoid hemorrhage (SAH) causes BATS: Berry aneurysm Arteriovenous malformation/adult polycystic kidney disease Trauma Stroke
Syncope causes, by system HEAD HEART VESSELS: CNS causes include HEAD: Hypoxia/hypoglycemia Epilepsy Anxiety Dysfunctional brain stem (basivertebral TIA) Cardiac causes are HEART: Heart attack Embolism (PE) Aortic obstruction (IHSS, AS or myxoma) Rhythm disturbance, ventricular Tachycardia Vascular causes are VESSELS: Vasovagal Ectopic (reminds one of hypovolemia) Situational Subclavian steal ENT (glossopharyngeal neuralgia) Low systemic vascular resistance (Addison's, diabetic vascular neuropathy) Sensitive carotid sinus
Tension pneumothorax: signs and symptoms P-THORAX Pleuritic pain Tracheal deviation Hyperresonance Onset sudden Reduced breath sounds (and dyspnea) Absent fremitus X-ray shows collapse
TWEED SASH Non-pharmacological analgesia.
Ventricular fibrillation: treatment Shock, shock, shock, everybody shock, little shock, big shock, momma shock, poppa shock: Shock= Defibrillate Everybody= Epinephrine Little= Lidocaine Big= Bretylium Momma= MgSO4 Poppa= Procainamide
Causes of fracture non-union SPLINT
Soft tissue interposition Position of reduction Location of fracture Infection Nutritional (damaged vessel/ diseased bone) Tumour (pathological fracture)
Classical signs of acute compartment syndrome The 6 P's of comPartment syndrome:
Pain. Paresthesia. Poikilothermia. Pallor. Paralysis. Pulselessness.
Endocrine
Diabetes complications KNIVES: Kidney – nephropathy Neuromuscular – peripheral neuropathy, mononeuritis, amyotrophy Infective – UTIs, TB Vascular – coronary/cerebrovascular/peripheral artery disease Eye – cataracts, retinopathy Skin – lipohypertrophy/lipoatrophy, necrobiosis lipoidica
Hematology/oncology
Anterior mediastinal masses 4 T's: Teratoma Thymoma Thyroid tissue T-cell / Hodgkin's lymphoma
Dermatomyositis or polymyositis: risk of underlying malignancy Risk is 30% at age 30. Risk is 40% at age 40, and so on.
Lung cancer: main sites for distant metastases BLAB: Bone Liver Adrenals Brain
Bone metastases: cancers that frequently metastasize to the bone BLT with a Kosher Pickle: Breast Lung Thyroid Kidney (Renal cell) Prostate
Esophageal cancer: risk factors ABCDEF: Achalasia Barret's esophagus Corrosive esophagitis Diverticuliis Esophageal web Familial
Lung cancer: notorious consequences SPEECH: Superior vena cava syndrome Paralysis of diaphragm (phrenic nerve) Ectopic hormones Eaton-Lambert syndrome Clubbing Horner syndrome/ hoarseness
Mole: signs of trouble ABCDE: Asymmetry Border irregular Colour irregular Diameter usually > 0.5 cm Elevation irregular
Prognotic factors for cancer: general PROGNOSIS: Presentation (time & course) Response to treatment Old (bad prog.) Good intervention (i.e. early) Non-compliance with treatment Order of differentiation (>1 cell type) Stage of disease Ill health Spread (diffuse)
Pituitary endocrine functions often affected by pituitary-associated tumor "Go look for the adenoma please": Tropic hormones affected by growth tumor are: GnRH LSH FSH ACTH Prolactin function
Interviewing / physical exam
Abdominal assessment To assess abdomen, palpate all 4 quadrants for DR. GERM: Distension: liver problems, bowel obstruction Rigidity (board like): bleeding Guarding: muscular tension when touched Evisceration/ ecchymosis Rebound tenderness: infection Masses
Altered level of consciousness: reasons AEIOU TIPS Alcohol Epilepsy, electrolytes, and encephalopathy Insulin Overdose, oxygen Underdose, uremia Trauma, temperature Infection Psychogenic, poisons Stroke, shock
Deep tendon reflexes (DTR's) One two, put on my shoe - S1/2 roots for Achilles reflex (foot plantarflexion) Three four, kick the door - L3/4 roots for patellar reflex (knee extension) Five six, pick up sticks - C5/6 roots for brachioradialis and biceps brachii reflexes (elbow flexion) Seven eight, shut the gate - C7/8 roots for triceps brachii reflex (elbow extension)
Causes of symptoms: OPQRST OPQRST is a mnemonic used to assess symptoms in clinical settings, particularly in emergency medicine.
O — Onset (when symptoms began) P — Provocation/palliation (factors that exacerbate or relieve symptoms) Q — Quality (description of the pain or discomfort) R — Region/radiation (location of pain and any radiation to other areas) S — Severity (intensity of the symptoms) T — Time (duration and progression of symptoms)
Fetal monitoring VEAL CHOP
Neurovascular assessment 5 P's: Pain Pallor Paresthesia Pulse Paralysis
Trauma assessment DCAP-BTLS Deformities & discolorations Contusions Abrasions & avulsion Penetrations & punctures Burns Tenderness Lacerations Swelling & symmetry BP-DOC Bleeding Pain Deformities Open wounds Crepitus
Toxicological seizures: causes OTIS CAMPBELL Organophosphates Tricyclic antidepressants Isoniazid, insulin Sympathomimetics Camphor, cocaine Amphetamines Methylxanthines PCP, propoxyphene, phenol, propranolol Benzodiazepine withdrawal, botanicals Ethanol withdrawal Lithium, lidocaine Lindane, lead
Vomiting: non-GIT differential ABCDEFGHI: Acute renal failure Brain [increased ICP] Cardiac [inferior MI] DKA Ears [labyrinthitis] Foreign substances [paracetamol, theo, etc.] Glaucoma Hyperemesis gravidarum Infection [pyelonephritis, meningitis]
Heart valve auscultation sites "All patients take meds": Reading from top left: Aortic Pulmonary Tricuspid Mitral
Glasgow coma scale: components and numbers Scale types is 3 V's: Visual response Verbal response Vibratory (motor) response Scale scores are 4,5,6: Scale of 4: see so much more Scale of 5: talking jive Scale of 6: feels the pricks (if testing motor by pain withdrawal)
Mental state examination: stages in order "Assessed mental state to be positively clinically unremarkable": Appearance and behaviour [observe state, clothing...] Mood [recent spirit] Speech [rate, form, content] Thinking [thoughts, perceptions] Behavioural abnormalities Perception abnormalities Cognition [time, place, age...] Understanding of condition [ideas, expectations, concerns]
History SAMPLE history Signs and symptoms Allergies Medications Past medical history, injuries, illnesses Last meal/intake Events leading up to the injury and/or illness OPQRST history Onset of symptoms Provocation/pallitive Quality or character of pain Region of pain or radiation Signs, symptoms and severity Time of onset, duration, intensity
Orthopaedic assessment CLORIDE FPP Character: sharp or dull pain Location: region (joint) of origin Onset: sudden vs. gradual Radiation: Intensity: how severe (scale 1–10), impact on ADLs (activities of daily living), is it getting better, worse or staying the same? Duration: acute vs. chronic Events associated: falls, morning stiffness, swelling, redness, joint clicking or locking, muscle cramps, muscle wasting, movement limitation, weakness, numbness or tingling, fever, chills, trauma (mechanism of injury), occupation activities, sports, repetitive movements Frequency: intermittent vs. constant, have you ever had this pain before? Palliative factors: is there anything that makes it better? (rest, activity, meds, heat, cold) Provocative factors: is there anything that makes it worse? (rest, activity, etc.)
Pain history checklist SOCRATES: Site Onset Character Radiation Alleviating factors/ associated symptoms Timing (duration, frequency) Exacerbating factors Severity Alternatively, signs and symptoms with the 'S' PLOTRADIO Past history Location Onset/offset Type/character (of pain) Radiation Aggravating/alleviating factors Duration Intensity Other associated symptoms
Abdominal swelling causes 9 F's: Fat Feces Fluid Flatus Fetus Full-sized tumors Full bladder Fibroids False pregnancy
Head trauma: rapid neuro exam 12 P's Psychological (mental) status Pupils: size, symmetry, reaction Paired ocular movements Papilloedema Pressure (BP, increased ICP) Pulse and rate Paralysis, paresis Pyramidal signs Pin prick sensory response Pee (incontinent) Patellar reflex Ptosis
Ocular bobbing vs. dipping "Breakfast is fast, dinner is slow, both go down": Bobbing is fast Dipping is slow In both, the initial movement is down.
Pupillary dilation (persistent): causes 3AM: 3rd nerve palsy Anti-muscarinic eye drops (e.g. to facilitate fundoscopy) Myotonic pupil
Clinical examination: initial Inspection of patient from end of bed ABC: Appearance (SOB, pain, etc.) Behaviour Connections (drips, inhalers, etc. connected to patient)
Differential diagnosis checklist "A VITAMIN C" Acquired Vascular Inflammatory (infectious and non-infectious) Trauma/ toxins Autoimmune Metabolic Idiopathic Neoplastic Congenital
Primitive reflexes "Absent reflexes should get paediatrics professors mad" Absent: asymmetrical tonic neck reflex Reflexes: rooting reflex Should: suck reflex Get: grasp reflex Paediatrics: placing reflex Professors: parachute reflex Mad: Moro reflex
Family history (FH) BALD CHASM: Blood pressure (high) Arthritis Lung disease Diabetes Cancer Heart disease Alcoholism Stroke Mental health disorders (depression, etc.)
Four point physical assessment of a disease "I'm a people person" Inspection Auscultation Percussion Palpation
Medical history: disease checklist MJ THREADS: Myocardial infarction Jaundice Tuberculosis Hypertension Rheumatic fever/ rheumatoid arthritis Epilepsy Asthma Diabetes Strokes
Past medical history (PMH) VAMP THIS: Vices (tobacco, alcohol, other drugs, sexual risks) Allergies Medications Preexisting medical conditions Trauma History of hospitalizations Immunizations Surgeries SMASH FM: Social history Medical history Allergies Surgical history Hospitalizations Family history Medications
Patient examination organization SOAP: Subjective: what the patient says. Objective: what the examiner observes. Assessment: what the examiner thinks is going on. Plan: what they intend to do about it
Patient profile (PP) LADDERS: Living situation/ lifestyle Anxiety Depression Daily activities (describe a typical day) Environmental risks / exposure Relationships Support system / stress
Physical exam for 'lumps and bumps' "6 students and 3 teachers go for CAMPFIRE": Site, size, shape, surface, skin, scar Tenderness, temperature, transillumination Consistency Attachment Mobility Pulsation Fluctuation Irreducibility Regional lymph nodes Edge
Short stature causes RETARD HEIGHT: Rickets Endocrine (cretinism, hypopituitarism, Cushing's) Turner syndrome Achondroplasia Respiratory(suppurative lung disease) Down syndrome Hereditary Environmental (postirradiation, postinfectious) IUGR GI (malabsorption) Heart (congenital heart disease) Tilted backbone (scoliosis)
Sign vs. symptom S&S: Sign: I (the examiner) can detect attributes/reactions without patient description Symptom: patient only can sense attributes/feelings
Social history FED TACOS: Food Exercise Drugs Tobacco Alcohol Caffeine Occupation Sexual activity
Surgical sieve for diagnostic categories INVESTIGATIONS: Iatrogenic Neoplastic Vascular Endocrine Structural / mechanical Traumatic Inflammatory Genetic / congenital Autoimmune Toxic Infective Old age / degenerative Nutritional Spontaneous / idiopathic
Surgical sieve for diagnostic categories (alternate) PAST MIDNIGHT: Psychological Autoimmune Spontaneous/idiopathic Toxic Metabolic Inflammatory Degenerative Neoplastic Infection Genetic Hematological Traumatic VITAMIN CDEF: Vascular Infective/inflammatory Traumatic Autoimmune Metabolic Iatrogenic/idiopathic Neoplastic Congenital Degenerative/developmental Endocrine/environmental Functional
Breast history checklist LMNOP: Lump Mammary changes Nipple changes Other symptoms Patient risk factors
Delivering bad news SPIKES: Setting up Perception Invitation Knowledge Emotions Strategy and summary
Nephrology
Dialysis: Acute indications AEIOU Acidosis (refractory to treatment) Electrolyte abnormalities (refractory to treatment, e.g. hyperkalemia) Ingestions (e.g. methanol, ethylene glycol, lithium, salicylates) Overload (volume overload refractory to IV diuresis) Uremia (presenting with pericarditis, bleeding, encephalopathy)
Neurology
Chorea: common causes St. VITUS'S DANCE: Sydenhams Vascular Increased RBC's (polycythemia) Toxins: CO, Mg, Hg Uremia SLE Senile chorea Drugs APLA syndrome Neurodegenerative conditions: HD, neuroacanthocytosis, DRPLA Conception related: pregnancy, OCP's Endocrine: hyperthyroidism, hypo-, hyperglycemia
Congenital myopathy: features DREAMS: Dominantly inherited, mostly Reflexes decreased Enzymes normal Apathetic floppy baby Milestones delayed Skeletal abnormalities
Dementia: reversible dementia causes DEMENTIA: Drugs/depression Elderly Multi-infarct/medication Environmental Nutritional Toxins Ischemia Alcohol
Friedreich ataxia trinucleotide repeat "Ataxic GAAit" Guanine Adenine Adenine
Stroke risk factors HEADS: Hypertension/ hyperlipidemia Elderly Atrial fib Diabetes mellitus/ drugs (cocaine) Smoking/sex (male)
Horner syndrome Horny PAMELA: Ptosis Anhydrosis Miosis Enophthalmos Loss of ciliary-spinal reflex Anisocoria
Cerebellar signs DANISH:
Dysdiadochokinesia / dysmetria Ataxia Nystagmus (horizontal) Intention tremor Slurred speech Hypotonia
Causes of pinpoint pupils Pinpoint pupils are caused by opioids and pontine pathology
Diagnostic criteria of neurofibromatosis type 1 CAFÉ SPOT:
Café au lait spots Axillary + inguinal freckling Fibromas Eye: Lisch nodules Sphenoid dysplasia Positive family history Optic tumour (glioma)
Features of normal pressure hydrocephalus Wet, wobbly, wacky:
Wet = urinary incontinence Wobbly = ataxic gait Wacky = dementia
Pathology
Gynaecomastia causing drugs Some drugs create awesome knockers Spironolactone Digitalis Cimetidine Alcohol Ketoconazole
Psychiatry
Conduct disorder vs. antisocial personality disorder Conduct disorder is seen in children. Antisocial personality disorder is seen in adults.
Depression: symptoms and signs (DSM-IV criteria) AWESOME: Affect flat Weight change (loss or gain) Energy, loss of Sad feelings/ suicide thoughts or plans or attempts/ sexual inhibition/ sleep change (loss or excess) / social withdrawal Others (guilt, loss of pleasure, hopeless) Memory loss Emotional blunting
Depression UNHAPPINESS: Understandable (such as bereavement, major stresses) Neurotic (high anxiety personalities, negative parental upbringing, hypochondriasis) Agitation (usually organic causes such as dementia) Pseudodementia Pain Importuning (whingeing, complaining) Nihilistic Endogenous Secondary (i.e. cancer at the head of the pancreas, bronchogenic cancer) Syndromal
Delirium DIMES & 3Ps: Drugs (or withdrawal) Infection (PUS = Pneumonia, UTI, Skin) Metabolic (e.g. Na, Ca, TSH) Environmental Structural Pain Pee Poo I WATCH DEATH Infections – PUS, CNS Withdrawal – alcohol, sedatives, barbiturates Acute metabolic changes – pH, hypo/hyper Na, Ca, acute liver or renal failure Trauma – brain injury, subdural hematoma CNS – post-ictal, stroke, tumour, brain mets Hypoxia – CHF, anemia Defficiencies – thiamine, niacin, B12 (e.g. chronic G and T alcoholics) Endocrinopathies – hypo-/hyper-cortisol, hypoglycemia Acute vascular – hypertensive encephalopathy, septic hypotension Toxins and Drugs – especially anti-cholinergics, opioids, benzodiazepines Heavy metals PINCH ME Pain Infection Nutrition Constipation Hydration Medication Electrolytes
Erikson's developmental stages "The sad tale of Erikson Motors":
The stages in order by age group: Mr. Trust and MsTrust had an auto they were ashamed of. She took the initiative to find the guilty party. She found the industry was inferior. They were making cars with dents [identity] and rolling fuses [role confusion]. Mr. N.T. Macy [intimacy] isolated the problem, General TVT absorbed the cost. In the end, they found the tires were just gritty and the should have used de- spare!
Mental state examination ASEPTIC: Appearance Speech Emotion (objective/subjective) Perceptions Thoughts Insight Cognition
Mania: cardinal symptoms DIG FAST: Distractibility Indiscretion (DSM-IV's "excessive involvement in pleasurable activities") Grandiosity Flight of ideas Activity increase Sleep deficit (decreased need for sleep) Talkativeness (pressured speech)
Mania: diagnostic criteria Must have 3 of MANIAC: Mouth (pressure of speech)/ Mood Activity increased Naughty (disinhibition) Insomnia Attention (distractibility) Confidence (grandiose ideas)
Parasomnias: time of onset Sleep terrors and Sleepwalking occur during Slow-wave sleep (stages 3 & 4).Nightmare occurs during REM sleep (and is remembered).
Psychiatric review of symptoms "Depressed patients seem anxious, so call psychiatrists": Depression and other mood disorders (major depression, bipolar disorder, dysthymia) Personality disorders (primarily borderline personality disorder) Substance abuse disorders Anxiety disorders (panic disorder with agoraphobia, obsessive-compulsive disorder) Somatization disorder, eating disorders (these two disorders are combined because both involve disorders of bodily perception) Cognitive disorders (dementia, delirium) Psychotic disorders (schizophrenia, delusional disorder and psychosis accompanying depression, substance abuse or dementia)
Schizophrenia: negative features 4 A's: Ambivalence Affective incongruence Associative loosening Autism
Substance dependence: features (DSM IV) WITHDraw IT:
3 of 7 within 12-month period: Withdrawal Interest or Important activities given up or reduced Tolerance Harm to physical and psychosocial known but continue to use Desire to cut down, control Intended time, amount exceeded Time spent too much
Radiology
Chest radiograph: checklist to examine "Pamela found our rotation particularly exciting; very highly commended mainly 'cus she arouses": Patient details Film details Objects (e.g. lines, electrodes) Rotation Penetration Expansion Vessels Hila Costophrenic angles Mediastinum Cardiothoracic ratio Soft tissues and bones Air (diaphragm, pneumothorax, subcut. emphysema)
Chest X-ray interpretation Preliminary is ABCDEF: AP or PA Body position Confirm name Date Exposure Films for comparison Analysis is ABCDEF: Airways (hilar adenopathy or enlargement) Breast shadows / bones (rib fractures, lytic bone lesions) Cardiac silhoutte (cardiac enlargement) / costophrenic angles (pleural effusions) Diaphragm (evidence of free air) / digestive tract Edges (apices for fibrosis, pneumothorax, pleural thickening or plaques) / extrathoracic tissues Fields (evidence of alveolar filling) / failure (alveolar air space disease with prominent vascularity with or without pleural effusions)
Chest X-ray: cavitating lesions differential "If you see holes on chest X-ray, they are weird": Wegener's granulomatosis (now known as granulomatosis with polyangiitis) Embolic (pulmonary, septic) Infection (anaerobes, pneumocystis, TB) Rheumatoid (necrobiotic nodules) Developmental cysts (sequestration) Histiocytosis Oncological Lymphangioleiomyomatosis Environmental, occupational Sarcoid Alternatively: L=Left atrial myxoma
Elbow ossification centers, in sequence CRITOE: Capitellum Radial head Internal epicondyle Trochlea Olecranon External epicondyle
Head CT scan: evaluation checklist "Blood can be very bad": Blood Cistern Brain Ventricles Bone
Neck sagittal x-ray: examination checklist ABCD: Anterior: look for swelling Bones: examine each bone for fractures Cartilage: look for slipped discs Dark spots: ensure not abnormally big, or could mean excess blood
Osteoarthritis: x-ray signs LOSS: Loss of joint space Osteopyhtes Subcondral sclerosis Subchondral cysts
T2 vs. T1 MRI scan "WW 2" (World War II): Water is white in a T2 scan. Conversely, a T1 scan shows fat as being whiter.
Upper lobe shadowing: causes BREASTS: Beryllium Radiation Extrinsic allergic alveolitis Ankylosing spondylitis Sarcoidosis TB Siliconiosis
Respiratory
Airway assessment LEMON
Look Evaluate Mallampati Occlusion Neck mobility PIPPA
Position Inspection Palpation Percussion Auscultation
Asthma management ASTHMA
Adrenergic agonists Steroids Theophylline Hydration Masked oxygen Anticholinergics
COPD assessment test (CAT) Source: CAT items: CHEST SEA To aid memory, think of the chest (or lungs) floating in a sea of yellow sputum, which is commonly seen in COPD.
Cough Home-leaving confidence Exercise tolerance (uphill/ 1 flight of stairs) Sputum (phlegm/ mucus) Tightness of chest Sleep Energy level ADL at home
Croup symptoms 3 S's: Stridor Subglottic swelling Seal-bark cough
Causes of upper zone pulmonary fibrosis A TEA SHOP
ABPA TB Extrinsic allergic alveolitis Ankylosing spondylitis Sarcoidosis Histiocytosis Occupational (silicosis, berylliosis) Pneumoconiosis (coal-worker's)
Features of a life-threatening asthma attack A CHEST
Arrhythmia/altered conscious level Cyanosis, PaCO2 normal Hypotension, hypoxia (PaO2<8kPa, SpO2 <92%) Exhaustion Silent chest Threatening PEF < 33% best or predicted (in those >5yrs old)
Pulmonary edema: treatment LMNOP: Lasix Morphine Nitro Oxygen Position/positive pressure ventilation
Miscellaneous The following may or may not fit properly into one of the above categories. They are being stored in this section either temporarily or permanently. Categorize them if needed.
Cholinergic crisis SLUDGE and the Killer B's: Salivation Lacrimation Urination Diaphoresis, diarrhea Gastrointestinal cramping Emesis Bradycardia Bronchospasm Bronchorrhea also known as DUMBBELLS Diarrhea Urination Miosis Bradycardia Bronchospasm Emesis Lacrimation Loss of muscle strength Salivation/sweating
Cheyne-Stokes breathing Cheyne-Stokes breathing sounds like "chain smokes" Drugs causing gynaecomastia: DISCO
Digitalis Isoniazid Spironolactone Cimetidine / ketoconazole Oestrogen
Drugs for bradycardia and hypotension Isoproterenol Dopamine Epinephrine Atropine sulfate
Diaphragm innervation C3, 4, 5 keeps the diaphragm alive
Intubation preparation 7 P's Preparation Preoxygenation Pretreatment Paralysis with induction Positioning Placement of tube Postintubation management
Medications that may be administrated by the endotracheal tube LEAN/NEAL Lidocaine hydrochloride Epinephrine Atropine Sulfate Naloxone hydrochloride
Pentad of TTP FAT RN: Fever Anemia Thrombocytopenia Renal Neuro changes
Systemic lupus erythematosus: diagnostic symptoms SOAP BRAIN MD Serositis Oral ulcers Arthritis Photosensitivity, pulmonary fibrosis Blood cells Renal, Raynaud's ANA Immunologic (anti-Sm, anti-dsDNA) Neuropsych Malar rash Discoid rash however, not in order of diagnostic importance.
Causes of carpal tunnel syndrome MEDIAN TRAP
Myxoedema Edema (heart failure, OCP, pre-menstrual) Diabetes mellitus Idiopathic Acromegaly Neoplasia Trauma Rheumatoid arthritis Amyloidosis Pregnancy
Carpal tunnel syndrome management WRIST
Wear splint at night Rest Inject steroids Surgical decompression Take diuretics
References
Further reading Shahed Yousaf; Mubeen Chaudhry (2006), Mnemonics for Medical Undergraduates, PasTest, ISBN 1-904627-88-9. Khan, Khalid (2008), Mnemonics and Study Tips for Medical Students, CRC Press, ISBN 978-0-340-95747-9. Beech, Alan (2013), Science & Math Rhymes 2 Help U, Alan Beech, ISBN 978-0-615-89569-7. Epomedicine Medical Mnemonics