Friday, 6 November 2009, 11:06 AM

Site: Memorable Medicine - free online medical training

Course: Internal Medicine (IntMed)
Glossary: Mnemonics

10s:

Regarding phaeochromocytomas:

10% malignant
10% bilateral
10% extra-adrenal
10% calcified
10% children
10% familial (now known to be closer to 25%)
discussed 10 times more often than actually seen!

2Cs:

Regarding MEN II:

C - Carcinoma of the thyroid (medullary)

C - Catacholamines (phaeochromocytoma)

plus:

MEN IIa = parathyroid hyperplasia

MEN IIb = mucocutaneous neuromas (aka MEN III)

Compare MEN I (3Ps)

2s:

Causes of mediastinal (and tracheal) deviation:

• 2 pull the mediastinum:

• Collapse
• Fibrosis
• 2 push the mediastinum:
 • Pleural effusion
• Tension pneumothorax
• 2 don't move the mediastinum:
• Cavity
• Consolidation

33-92-CHEST:

Signs of life-threatening asthma:

33 - PEFR < 33% predicted/best

92 - Pulse oximetry < 92%

C - Cyanosis
H - Hypotension
E - Exhaustion or confusion
S - Silent chest
T - Tachycardia or bradycardia

3Ds:

Beck's triad:

D - Distant heart sounds

D - Distended jugular veins
D - Decreased arterial pressure

3Ps:

Regarding MEN I:

P - Pituitary adenoma
P - Parathyroid hyperplasia
P - Pancreatic tumours

Compare MEN II (2Cs)

4
4Hs 4Ts:

Reversible causes of cardiac arrest:

H - Hypothermia
H - Hypo & hyper-electrolytes
H - Hypovolaemia
H - Hypoxia

T - Toxic (including drugs)

T - Trauma
T - Tamponade
T - Tension pneumothorax

4Ts:

Differential diagnosis of an anterior mediastinal mass:

T - Thyroid tumour
T - Thymoma
T - Teratoma
T - Terrible Lymphoma

5Ss:

Causes of leucoplakia:

S - Spirits
S - Smoke
S - Sepsis
S - Syphillis
S - Sore teeth

6As:

Features of ankylosing spondylitis:

A - Axial arthropathy
A - Ankylosis
A - Anterior uveitis
A - Apical lung fibrosis
A - Aortic regurgitation
A - Achilles tendonitis

8Ss:

Features of innocent murmurs:

S - Soft
S - Systolic
S - Short
S - Sounds (S1 & S2) normal
S - Symptomless
S - Special tests normal (X-ray, EKG)
S - Standing/ Sitting (vary with
position)
S - Sternal depression

A-B-C-D:

Causes of normocytic anaemia (normal MCV):

A - Acute blood loss

B - Bone marrow failure
C - Chronic disease
D - Destruction (haemolysis) = SHEEP TIT

ABC:

Risk factors for aortic dissection:

A - Atherosclerosis / Ageing / Aortic aneurysm

B - Blood pressure high / Baby (pregnancy)
C - Connective tissue disorders (eg Marfan's syndrome, Ehlers-Danlos syndrome) / Cystic medial necrosis

ABCD:
In treating hypertension:

A - ACE inhibitors
B - Beta blockers

C - Calcium channel antagonists

D - Diuretics (thiazide)

A&B are usually indicated for under 55 year-olds and C&D are usually indicated for those 55 years or over and black patients.
This is due to the aetiology of hypertension in these groups. When dual therapy is required one from A&B and one from C&D
are usually chosen.

ABCDE:

Management choices of supraventricular tachycardia:

A - Adenosine
B - Beta-blocker
C - Calcium channel antagonist
D - Digoxin / DC cardioversion
E - Excitation (vagal stimulation)

ABCDEx2:

Possible complications of an MI:

A - Arrhythmias / Aneurysm
B - Bradycardia / ↓ Blood pressure
C - Cardiac failure / Cardiac tamponade
D - Dressler's syndrome / Death!
E - Embolism / Extra (VSD, papillary muscle rupture)

ACID:

Types of hypersensitivity reaction:

A-I Anaphylaxis

C - II Cytotoxic mediated

I - III Immune complex

D - IV Delayed hypersensitivity or cell

mediated
ARHYTHMIAL 3PC:

Causes of arrhythmias:

A - Atrial myxoma
R - Rheumatic heart disease
HY - HYpertension
TH - THyrotoxicosis
M - Mitral valve dis
I - IHD
AL - ALcohol

3P - Pneumonia / PE / Pericardial effusion

C - Cardiomyopathy

ARITHMATIC:

Causes of AF:

A - Alcohol
R - Rheumatic fever
I - Ischaemic heart disease
T - Thyrotoxicosis
H - Hypertension
M - Mitral stenosis / Myocardial infarction / atrial
Myxoma
A - Atrial septal defect
T - Toxins
I - Idiopathic / Infective endocarditis
C - Cardiomyopathy / Constrictive pericarditis

ASD:

Symptoms of aortic stenosis:

A - Angina (2 year prognosis)

S - Syncope (1 year prognosis)
D - Dyspnoea (6 month prognosis)

ASK ME:

JVP wave form:

A - Atrial contraction
S - Systole
K - Klosure (closure) of tricuspid valve, so atrial filling

M - Maximal atrial filling

E - Emptying of atrium

[Larger Image]

CARDIAC RIND:

Causes of pericarditis:

C - Collagen vascular disease

A - Aortic aneurysm
R - Radiation
D - Drugs (such as hydralazine)
I - Infections
A - Acute renal failure
C - Cardiac (myocardial) infarction

R - Rheumatic fever
I - Injury
N - Neoplasms
D - Dressler's syndrome

CHARM:

Causes of transudative pleural effusions:

C - Carditis
H - Hypothyroidism
A - Albumin ↓
R - Renal failure
M - Meigs' syndrome / Malabsorption

COLD PALMS:
Causes of peripheral cyanosis:
C - Cold
O - Obstruction
L - LVF and shock
D - Decreased cardiac output

Causes of central cyanosis:

P - Polycythemia
A - Altitude
L - Lung disease
M - Methaemoglobinaemia, sulphaemoglobinaemia
S - Shunt

COPD:

Causes of an impalpable apex beat:

C - COPD
O - Obesity
P - Pleural, Pericardial effusion
D - Dextrocardia

CREAMS:

Causes of aortic regurgitation:

C - Congenital
R - Rheumatic fever / Rheumatoid arthritis
E - Endocarditis
A - Aortic dissection / Aortic root dilatation / Ankylosing spondylitis
M - Marfan's syndrome
S - Syphilis

CURB:

To make a quick assessment of the severity of pneumonia:

C - Confusion
U - Urea
R - Respiratory rate
B - Blood pressure

See CURB-65 for mortality etc.

CUSHINGOID:

Side-effects of steroids:

C - Cataracts
U - Ulcers (peptic)
S - Skin (thin, briusing, striae)
H - Hypertension / Hirsuitism / buffalo Hump
I - Infections
N - Necrosis (femoral head AVN)
G - Glycosuria
O - Osteoporosis / Obesity (centripetal & moon face)
I - Immunosuppression
D - Diabetes mellitus

DANISH:

Signs of cerebellar disease:

D - Dysdiadochokinesis
A - Ataxia
N - Nystagmus (ipsilateral)
I - Intention tremor
S - Slurred speech
H - Hypotonia / Heel-toe walking impaired

DISK MASS:

Differential diagnosis of back pain:

D - Degeneration: degenerative joints, osteoporosis, spondylosis

I - Infection: UTI, PID, Pott's disease, osteomyelitis, prostatitis, injury/fracture, compression fracture.
S - Spondylitis, ankylosing spondyloarthropathies (RA, Reiter's disease, SLE)
K - Kidney stones/infarction/infection (pyelonephritis/abscess)

M - Metastasis from breast, prostate, lung, thyroid, kidney cancer, Multiple myeloma
A - AAA
S - Slipped disk, Spondylolisthesis
S - Strain, Scoliosis/lordosis, Skin: herpes zoster

DOPES:
The reasons for no palpable apex beat:

D - Dextrocardia (don't say this first!)

O - Obesity
P - Pleural/Pericardial effusion
E - Emphysema
S - Shock

DRUMSTICX:

Causes of pericarditis:

D - Dressler's syndrome
R - Rheumatic fever / RA
U - Uraemia
M - MI
S - SLE
T - Trauma
I - Idiopathic
C - Coxsackie virus
X - X–ray

DULL JAM:

D - DM
U - Uraemia
L - Lymphoma
L - Leukaemia

J - Jaundice
A - Anaemia
M - Myxoedema

ELEVATION:

Causes of ST elevation:

E - Electrolyte imbalance
L - Left bundle branch block
E - Early repolarization
V - Ventricular hypertrophy
A - Aneurysm
T - Treatment (eg pericardiocentesis)
I - Injury (myocardial infarction, contusion)
O - Osborn waves (hypothermia)
N - Non-occlusive vasospasm (Prinzmetal's angina)

FAB:

Causes of macrocytic anaemia (high MCV; MacDonalds do FAB burgers!):

F - Folate deficiency
A - Alcohol abuse (since concurrent thiamine deficiency)
B - B12 (thiamine) deficiency

Note B12 deficiency causes neurological signs.

FAILURE:

Causes of acute CCF:

F - Forgot medication
A - Arrhythmia / Anaemia
I - Ischaemia / Infarction / Infection
L - Lifestyle: too much salt
U - Upregulation of CO: pregnancy, hyperthyroidism
R - Renal failure
E - Embolism: pulmonary

FIPPY:

Causes of a third heart sound:

F - Failure
I - Incompetence (mitral valve / tricuspid
valve)
P - Pregnancy / Pill
P - Pulmonary embolus / Pericarditis
Y - Youth

FOAM:
Management of acute LVF:

F - Frusemide
O - Oxygen
A - Atrovent (& ventolin)
nebuliser
M - Morphine

FOAMS:

In the treatment of acute pulmonary oedema (LVF):

F - Frusemide (iv)
O - Oxygen
A - Atrovent (& Ventolin) nebuliers
M - Morphine (iv)
S - Sit up!

HANDI:

Causes of postural hypotension:

H - Hypovolaemia / Hypopituitarism
A - Addison's disease
N - Neuropathy (autonomic)
D - Drugs (vasodilators, diuretics, antipsychotics)
I - Idiopathic

HARD:

Types of cardiomyopathy:

H - Hypertrophic cardiomyopathy
A - Arrhythmogenic right ventricular
cardiomyopathy
R - Restrictive cardiomyopathy
D - Dilated cardiomyopathy

HEART:
Some causes of AF:

H - Heart failure (including cardiomyopathies)

E - Enlargement of the atria
A - Alcohol
R - Rheumatic heart disease
T - Thyroxine ↑

HILT:

Findings with an apex beat:

H - Heaving
I - Impalpable (COPD)
L - Laterally displaced
T - Thrusting / Tapping

HOLT:

Causes of JVP elevation:

H - Heart failure
O - Obstruction of vena cava
L - Lymphatic enlargement - supraclavicular
T - (intra) Thoracic pressure increase

HOPEFULSSS:

Risk factors for coronary artery disease:

H - Hypertension
O - Obesity
P - PVD
E - Elevated LDL
F - Family history
U - Up glucose - DM
L - Low HDL
S - Smoking
S - Sex - male
S - Sedentary lifestyle

HOT ACROMEGALY:
Clinical features of acromegaly:

H - Heart failure / Hypertension

O - Organomegaly
T - Teeth widely spaced

A - Amenorrhoea
C - Carpal tunnel syndrome / Coarse skin/voice / Cardiovascular disease
R - Respiratory - sleep apnoea and upper airway obstruction
O - Oily skin
M - Myopathy / Malignancy (higher risk of several types)
E - Eye (prominent supra-orbital ridge)
G - Goitre / Gain weight / Galactorhoea / Glucosuria
A - Arthropathy
L - Large tongue, nose, hands and feet
Y - Young get gigantism (since growth plates not yet fused)

I PUNCH EAR:

Areas to cover in a systems review:

I - Integumental

P - Pulmonary
U - Urogenital
N - Nervous
C - Cardiovascular
H - Hematolymphoid

E - Endocrine
A - Alimentary
R - Reproductive

ICE:

When in a consultation remember to address patient:

I - Ideas (what they think might be wrong)

C - Concerns (what they are worried about)
E - Expectations (what they want done)

If Testing Plantar Reflexes, Carefully Stroke:

When performing a PNS examination:

I - Inspection
T - Tone
P - Power
R - Reflexes
C - Co-ordination
S - Sensation (light touch, pain, vibration, proprioception)

INVERT:

Causes of T wave inversion:

I - Ischaemia
N - Normal (especially young, black)
V - Ventricular hypertrophy
E - Ectopic foci (eg calcified plaques)
R - RBBB, LBBB
T - Treatments (digoxin)

IPPA:

When examining a patient, stick to the order:

I - Inspection
P - Palpation
P - Percussion
A - Ausculation

IT'S COMA:

Causes of a coma:

I - Infection (meningitis, encephalitis, sepsis)

T - Trauma
S - Seizures

C - CVA
O - Overdose (opioids, poisoning, eg carbon monoxide)
M - Metabolic, eg hypoglycemia, hyponatremia
A - Alcohol

J
JONES cRITERIA:

Revised Jones' criteria for rheumatic fever.

Major criteria:
J - Joints (migratory polyarthritis)
O - Obvious (cardiac = carditis with heart failure, pericarditis, or new murmur)
N - Nodule (subcutaneous rheumatic)
E - Erythema marginatum
S - Sydenham's chorea

Minor criteria:
R - Rheumatic fever previously
I - Inflammatory cells (leukocytosis)
T - Temperature (fever)
E - Elevated ESR / CRP
R - Raised PR interval
I - Infection (evidence of Group A Streptococcal infection)
A - Arthralgia

LAMB:

Choiced of medical management of ventricular tachycardias include:

L - Lidocaine
A - Amiodarone
M - Magnesium / Mexiltene
B - Beta-blocker

LOSS:

Features of osteoarthritis on an X-ray:

L - Loss of joint space (if x-ray is taken whilst weight-bearing)

O - Osteophytes
S - Subcondral Cysts
S - Sclerosis

MAD HIVES:
Causes of delirium:

M - Metabolic, eg liver failure, renal failure

A - Alcohol withdrawal
D - Drugs

H - Hypoxia, eg COPD
I - Infection, eg UTI
V - Vascular, eg CVA, MI
E - Epilepsy (postictal)
S - Subdural haemorrhage

MBA College:

Anti-arrhythmics in order from class I to IV:

M - Membrane stabilisers
B - Beta-blockers
A - Action potential wideners

C - Calcium channel antagonists

MI CHAM:

Causes of lymphoedema (non-pitting oedema):

M - Milroys
I - Infection (filariasis)

C - Congenital
H - Hypothyroid
A - Allergy
M - Malignancy

MONA:

Immediate treatment of an MI:

M - Morphine
O - Oxygen
N - Nitrates
A - Aspirin
OH BATMAN is a bit more
inclusive.

MOP HAIR:

Characteristics of a JVP:

M - Multiple wave form

O - Occludable
P - Postural changes
H - Hepatojugular reflex
A - Above (fills from)
I - Impalpable
R - Respiratory changes

See also ASK ME.

MUDPILES:

Causes of a high anion gap:

M - Methanol
U - Uraemia
D - DKA
P - Propylene glycol
I - Isoniazid
L - Lactic acidosis
E - Ethylene glycol
S - Salicylates

NERO:

X-ray features of RA:

N - Nodules
E - Erosions
R - Reduced joint space
O - Osteoporosis (peri-articular)
Never Let Monkeys Eat Bananas: 60, 30, 6, 3, 1:

As a normal proportion of the total WCC:

N - Neutrophils 60%
L - Lymphocytes 30%
M - Monocytes 6%
E - Eosinophils 3%
B - Basophils 1%

OH BATMAN:

In the treatment of an MI:

O - Oxygen
H - Heparin (NSTEMI)

B - Beta blockers
A - Aspirin
T - Thrombolysis (STEMI)
M - Morphine
A - Angioplasty
N - Nitrates

PAD HIM:

Causes of bradycardia:

P - Physiological (athlete, sleep) / Paroxysmal

A - AV block (heart block) (Mobitz II & third
degree)
D - Drugs (beta blockers, digoxin, amiodarone)

H - Hypothyroid / Hypothermia
I - Icteric (severe)
M - MI

PAID:
P - Pulmonary and
A - Aortic
I - Insufficiency
produce
D -Diastolic murmurs

PAM:

Horner's syndrome consists of (PAM Horner!):

P - Ptosis
A - Anhydrosis
M - Miosis

PANIC:

In the first hour of treating DKA think about:

P - Potassium (20 mmol KCl if no tented T waves on ECG)

A - Acidosis (if pH < 7.30 get urgent advice)
N - Normal saline (1 litre in the first hour)
I - Insulin (6 units stat then 6 units per hour)
C - Catheter and Cultures (urine, blood, sputum, etc)

PASS:

P - Pulmonary and
A - Aortic
S - Stenosis produce
S - Systolic murmurs

PASTRI:

Complications of mitral stenosis:

P - Pulmonary hypertension
A - AF
S - Systemic embolism
T - Tricuspid regurgitation
R - Right heart failure
I - Infective endocarditis
PINTARS:

Causes of exudative pleural effusions:

P - Pneumonia / Pancreatitis
I - Infarction (PE)
N - Neoplasm
T - TB / Trauma
A - Abscess
R - RA
S - Systemic stuff (SLE, Sarcoidosis, Systemic sclerosis)

PIRATES:

Causes of AF:

P - Pulmonary: PE, COPD

I - Iatrogenic
R - Rheumatic heart: mirtral regurgitation
A - Atherosclerotic: MI, CAD
T - Thyroid: hyperthyroid
E - Endocarditis
S - Sick sinus syndrome

Ps:

In psoriasis:
psilver pscale over psalmon psikn!

RAISE:

Causes of metabolic acidosis with a normal anion gap and RAISEd K+ (hyperkaleamia):

R - Renal tubular acidosis type 4

A - Alsosterone or meralocordicoid deficiency
I - Iatrogenic: NH4Cl, HCl
S - Stenosis: obstructive uropathy
E - Early uraemia

See also ReDUCE.

RAMP:

Contraindications to exercise ECGs:

R - Recent MI
A - Aortic stenosis
M - MI in the last 7 days
P - Pulmonary hypertension

Really Sick Children Must Take No Exercise:

Number of days after fever onset, that the rash appears:

R - 1: Rubella
S - 2: Scarlet fever / Smallpox
C - 3: Chickenpox
M - 4: Measles (with Koplik spots 1 day earlier)
T - 5: Typhus, rickettsia (variable)
N - 6: Nothing
E - 7: Enteric fever (salmonella)

ReDUCE:

Causes of metabolic acidosis with normal anion gap and ReDUCEd K+ (hypokalaemia):

Re - Renal tubular acidosis types 1 & 2

D - Diarrhoea
U - Urine diversion into gut
C - Carbonic anhydrase inhibitor
E - Ex-hyperventilation

See also RAISE.

RILE:

Effect of respiration on intensity of heart murmurs:

R - Right sided murmurs loudest on

I - Inspiration
L - Left sided murmurs loudest on
E - Expiration
 S

SAVER:

Compensatory mechanisms in shock:

S - Sympathoadrenal system
A - Atrial natriuretic peptide
V - Vasopressin
E - Endogenous digitalis-like factor
R - Renin-angiotensin-aldosterone system

SCRIPT:

Things to think about when hearing a murmur:

S - Site
C - Character (eg harsh, soft, blowing)
R - Radiation
I - Intensity
P - Pitch
T - Timing

SHEEP TIT:

Causes of haemolysis:

S - Sickle cell disease

H - Hereditary spherocytosis
E - Enzyme deficiencies (G6PD, pyruvate
kinase)
E - Erythroblastosis fetalis
P - Paroxysmal nocturnal haemoglobinuria

T - Trauma to RBCs
I - Immunohaemolytics (warm Ab, cold Ag)
T - Thalassaemias

SHIFT MAID:

Risk factors for atherosclerosis:

S - Smoking
H - Hypertension
I - IDDM / NIDDM
F - Family history
T - Triglycerides, fats

M - Male
A - Age (increasing)
I - Inactivity
D - Diet / Drink

SHIT:

Causes of a fourth heart sound:

S - Stenosis (aortic/pulmonary)
H - Hypertension/Heart Block
I - Ischaemic heart disease
T - Tamponade

SHOVED:

When enquiring about the nervous system:

S - Syncope, Speech defect, Swallowing difficulty

H - Headache
O - Ocular distubances: diplopia, visual field defects
V - Vertigo
E - Epilepsy: seizures
D - Don't forget motor and sensory components of all nerves (pain, paraesthesia, weakness, incoordination...)

SLIM CV:

Causes of CAP:

S - Streptococcus pneumoniae
L - Legionella
I - Influenzae Hemophilus (HiB)
M - Mycoplasma

C - Chlamydia
V - Viral
SNAP:

Causes of SVT:

S - Sinus tachycardia
N - Nodal tachycardia
A - Atrial fibrillation
P - Paroxysmal atrial tachycardia

Some Hot Dude Better Give Iced Fluids Today:

Treatment of malignant hyperthermia:

S - Stop all triggering agents, give 100% O2

H - Hyperventilate
D - Dantrolene 2.5mg/kg
B - Bicarbonate
G - Glucose and Insulin
I - IV Fluids, cooling blanket
F - Fluid output; furosemide
T - Tachycardia, be prepared to treat ventricular tachycardia

SPLINT:

Causes of splinter haemorrhages:

S - Sepsis elsewhere
P - PAN / SLE / RA
L - Limey (vitamin C deficiency)
I - Infective endocarditis
N - Neoplasm (haematological)
T - Trauma

SSAALL:

Areas of the heart the ECG chest leads 'look' at:

S - V1 Septum
S - V2 Septum
A - V3 Anterior
A - V4 Anterior
L - V5 Lateral
L - V6 Lateral
 T

TAPED TORCH:

Signs of heart failure:

T - Tachycardia
A - Ascites
P - Pulsus alternans
E - Elevated jugular venous pressure
D - Displaced apex beat

T - Third heart sound

O - Oedema
R - Right ventricular heave
C - Crepitations or wheeze
H - Hepatomegaly (tender)

TICS:

Causes of microcytic anaemia (low MCV; Mics are TICS):

T - Thalassemia
I - Iron deficiency
C - Chronic disease
S - Sideroblastic anemia (can be secondary to lead)

TOM SCHREPFER:

Predisposing conditions for PE:

T - trauma
O - obesity
M - malignancy

S - surgery
C - cardiac disease
H - hospitalisation
R - rest (bed-bound)
E - estrogen, pregnancy, post-partum
P - past history
F - fracture
E - elderly
R - road trip
TONS:

Things to consider giving to a patient in a coma:

T - Thiaminie
O - O2
N - Naloxone
S - Sugar, eg 50% dextrose

TRACKPADS:

Causes of secondary hypertension:

T - Thyroid disease (hyperthyroidism)

R - Renovascular disease (renal artery stenosis)
A - Aorta, coarctation of
C - Cushing's syndrome
K - Kidney disease, chronic (CKD)
P - Pheochromocytoma
A - Aldosteronism (hyper-)
D - Drugs (eg OCP, decongestants, NSAIDs)
S - Sleep apnoea

TRIP SAM:

Causes of splinter haemorrhages:

T - Trauma
R - Rheumatoid arthritis
I - Infective Endocarditis
P - Poly arteritis nodosum

S - Systemic lupus erythematosus / Sepsis

A - Anaemia (profound)
M - Malignancy (haematological)

WiLLiaM MaRRoW:

WiLLiaM - W pattern in V1 & V2 and M pattern in V3, V4 & V6 is Left bundle branch
block.
MaRRoW - M pattern in V1 & V2 and W in V3, V4 & V6 is Right bundle branch block.

WORD:

Causes of a dominant R wave in V1:

W - WPW
O - Old MI / pOsterior MI
R - RBBB
D - Dextrocardia