# List of medical mnemonics

<span style="color:red"&#x3E;Note for editors: Please add a reference with your entry. Reference inclusion with original entry is much easier than post&#x2D;hoc addition.</span&#x3E; 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)

## 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

## 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.
Non-Pharmacological Analgesic Strategies :
| Psychological Interventions ||
| T | Therapeutic Touch (e.g. hand-holding) |
| W | Warn about painful interventions |
| E | Explain what is, or is about to, happen |
| E | Eye contact |
| D | Defend (patient) dignity |
| Physical Interventions ||
| S | Stabilise fractures |
| A | Apply dressings to cover burns |
| S | Soft surface (avoid rigid spinal boards or stretchers) |
| H | Hypothermia avoidance |

### 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= MgSO$_4$
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
Testicular-type
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
| FHR Pattern: | Variable | Early deceleration | Acceleration | Late deceleration |
| Meaning: | Cord compression | Head compression | O2 | Placental insufficiency |

### 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